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COLLEGE  OF  PHYSICIANS 
AND  SURGEONS 


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Given  by 


Hospital 
Accounting  and  Statistics 


Charitable  Institutions  may  obtain  a  copy  of  this 
book  free  of  charge  by  request  of  their  proper  ofl&cer 
upon  the  Treasurer  of  the  Presbyterian  Hospital,  41 
East  70th  Street,  New  York  City.  Other  copies  may 
be  secured  from  E.  P.  Dutton  &  Co.,  for  the  price 
of  $li»0  each,  postage  paid,  enclosed  with  order. 


Hospital 
Accounting  and  Statistics 

4th  Edition 
Compiled  and  Arranged  by 

William  V.  S.  Thome 

Treasurer  and  Member  of  the  Board  of  Managers  of  The  Presbyterian 
Hospital  in  the  City  of  New  York,  Chairman  of  the  Executive  Com- 
mittee eind  Member  of  the  Boaird  of  Governors  of  the  Woman's  Hospital 
in  the  State  of  New  York,  Member  of  the  Board  of  Directors  of  the 
Manhattan  Maternity  and  Dispensary. 

Author  of  the  booklet  entitled  "A  Central  Purchasing  Agency  for  the 
Hospitals  of  New  York"  (The  Hospital  Bureau  of  Standcirds  and 
Supplies  weis  organized  in  New  York  in  March,  1910,  in  accordance 
with  the  suggestions  outlined  in  the  booklet  referred  to,  and  has  now 
been  in  successful  operation  for  over  eight  years  and  includes  a  member- 
ship of  forty-nine  hospitals  of  which  thirty  are  located  outside  the  limits 
of  Greater  New  York). 


New  York 

E.  P.  DUTTON  &  CO. 

1918 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/hospitalaccountiOOthor 


PREFACE 

As  a  result  of  numerous  conferences  in  the  years  1906  and  1908 
between  the  Superintendents,  Treasurers  and  Accountants  of 
some  of  the  larger  hospitals  the  Schedules  shown  in  the  jfirst 
thirteen  pages  of  this  book  and  the  "Instructions  regarding  Distri- 
bution of  Hospital  Operating  and  Corporation  or  Other  Current 
Expenses"  were  agreed  upon  as  illustrating  desirable  forms  in 
which  hospitals  might  present  their  financial  reports  and  statistics. 

The  object  was  to  encourage  and  assist  hospitals  in  adopting  a 
simple  and  intelligentsystemof  accountingapprovedby  certifiedpub- 
lic  accountants  and  by  those  experienced  in  hospital  management. 

The  forms  of  accounts  and  statistics  described  (with  slight 
modifications  to  suit  the  special  requirements  of  certain  hospitals) 
would  readily  set  forth  in  a  nearly  uniform  manner  the  statements 
of  revenue  and  expenses,  assets  and  liabilities,  etc.,  desired  by 
most  hospital  managers  and  by  the  public  for  their  information 
and  for  intelligent  comparison  with  similar  reports  or  statements 
of  other  hospitals. 

Unless  such  accounts  and  statistics  are  made  up  on  some  uni- 
form basis  they  are  apt  to  be  misleading  and  valueless  for  purposes 
of  comparison. 

The  method  of  accounting  herein  described  has  now  been 
adopted  as  standard  by  a  large  number  of  hospitals  throughout 
the  United  States  and  Canada. 

The  Hospital  Saturday  and  Sunday  Association  of  New  York 
City  (now  known  as  The  United  Hospital  Fund  of  New  York), 
in  its  Thirty-third  Annual  Report  for  the  year  ended  September 
30,  1912,  pages  42  and  43,  stated  as  follows: 

"Improvement  in  Hospital  Statistics  and  Accounts" 

"Under  the  instruction  of  the  Trustees  a  new  form  of  Schedule 
was  introduced  for  the  reports  of  hospitals  to  this  Association, 
prepared  in  consultation  with  hospital  authorities  and  experts  in 
accounting  and  statistics.  It  was  well  received  by  the  hospitals, 
and  has  been  the  means  of  securing  fuller  and  more  significant 
data  regarding  the  'Work  Done,'  the  'Expenses,'  and  the  'In- 
come' of  the  Associated  Hospitals.  The  results  are  tabulated 
in  the  large  'Statistical  Sheet'  inserted  at  the  end  of  this  report, 
and  will  interest  general  contributors  and  those  responsible  for 
hospital  management. 

**  It  is  evident  that  the  requirement  by  the  Association  of  these  de- 


tailed  reports  has  called  attention  to  defects  in  methods  of  keeping 
accounts  and  statistics  to  some  degree,  and  has  led  to  improvement. 
This  is  one  of  the  main  objects  of  the  Association  and  points  the 
way  to  greater  economy  and  efficiency  in  hospital  management. 

"The  new  Schedule  for  reports  to  the  Association  calls  for 
items  which  the  management  of  any  well-regulated  hospital  should 
know.  The  labor  of  preparing  it  is  reduced  to  a  minimum  since 
it  is  in  harmony  with  the  data  required  by  the  State  Board  of 
Charities  and  with  the  Uniform  System  of  Accounts  and  Statistics 
already  in  use  among  the  leading  hospitals  of  this  and  other  cities 
and  which  all  would  find  it  advantageous  to  adopt." 

At  a  meeting  held  on  May  14,  1913,  the  Philadelphia  County 
Medical  Society  appointed  a  Committee  on  Hospital  Efficiency 
"for  the  purpose  of  considering  ways  and  means  by  which  the 
efficiency  of  the  hospitals  in  Philadelphia  may  be  increased." 

After  making  a  very  careful  and  thorough  study  of  the  hospital 
situation  in  Philadelphia  the  Committee  on  June  17th  and  Novem- 
ber 26,  1913,  and  on  October  21, 1914,  submitted  its  reports  con- 
taining a  summary  of  the  facts  gathered  and,  based  on  these  facts, 
a  series  of  recommendations. 

One  of  these  recommendations  was: 

"That  the  Coimty  Medical  Society  urge  every  hospital  in 
Philadelphia,  public  or  private: 

"To  adopt  a  uniform  system  of  hospital  records  and  reports  in 
order  to  furnish  a  common  basis  for  the  comparison  of  financial 
records  and  statistics  and  medical  records  and  statistics. 

"To  use  as  a  basis  for  the  proposed  system  of  uniform  reports 
the  forms  recommended  to  other  hospitals  by  various  institutions 
in  New  York  and  other  cities  in  the  volume  entitled  Hospital 
Accounting  and  Statistics.** 

This  fourth  edition  of  the  book  describes  more  fully  than 
previous  editions  matters  concerning  the  rendering  of  bills  against 
patients  and  also  refers  to  new  and  improved  forms  of  Superin- 
tendent's Bill  Book,  Bill  Register,  Patients'  Ledger  Account 
Cards  and  Cash  Receipt  Book,  which  should  help  minimize  clerical 
labor  in  the  Superintendent's  office  in  keeping  proper  and  accurate 
accounts  and  records. 

It  also  contains,  in  addition  to  the  matter  included  in  the 
previous  edition,  a  description  and  illustrations  (on  pages  101 
to  119)  of  desirable  forms  for  use  in  computing  statistics,  etc, 
concerning  patients  treated,  referred  to  in  Schedule  6,  on  pages 
11  to  13. 

Decebtber,  1918. 


CONTENTS 


Schedule  1,  Statement  of  Current  Revenue        ..... 
2,  Statement  of  Current  Expenses       ..... 

"        3,  Surplus  and  Deficit  Account  . 

"       4,  Balance  Sheet,  Treasurer's  ..... 

"        5,  Statement  of  Increase  or  Decrease  of  Principal  of  Capital 
Reserve  Funds      ........ 

"        6,  Statistics  Concerning  Patients         ..... 
Instructions  regarding  Distribution  of  Expenses 

Advantages  of  Uniform  and  Intelligent  Financial  Reports  and  Statistics 
Applicability  of  this  System  of  Accounting  to  all  Sorts  of  Charitable 

Institutions     ......... 

Double  Entry  System  of  Bookkeeping      ..... 

Soperintendent'8  Accounts  .         .         .  .  £5  to  60, 

Vouchers         ......... 

Expenses  Paid  by  Vouchers  through  the  Superintendent's  OflBce 

Pay  Rolls 

Unclaimed  Wages    ........ 

Time  Checks  ......... 

Advances  Paid  Account  Salaries  and  Wages 

Card  Record  of  Unclaimed  Wages      ..... 

Transfer  of  Unclaimed  Wages  to  Siu^lus  and  Deficit  Account 

Voucher  Register     ........ 

Bills  Rendered  to  Pay  Patients  ..... 

Bill  Register   ......... 

Statements  of  Account      ....... 

Card  Ledger  Accounts  with  Patients  and  Others 

Charges  for  Special  Nursing  and  Other  Miscellaneous  Charges 

Checking  Amount  of  Special  Nursing  Charges 

Charges  against  Patients  for  Telephone  Messages 

Bills  for  Advance  Payments      ...... 

Bills  for  Hospital  Earnings  Accrued  ..... 

Hospital  Earnings  Cash  Receipt  Book        .... 

Superintendent's  General  Cash  Book  .         . 

Cash  Remittances  by  Treasurer  to  Superintendent 
'•  "  by  Superintendent  to  Treasurer 

Superintendent's  Bank  Accounts 
Petty  Cash  Book 
**  Journal  and  Journal  Entries 

"  General  Material  Account 

Sale  of  Supplies  Credited  to  Current  Expenses 


PAGES 

2.3 
4,5,6 

7 
8.  9 

10 

11,  12,  13 

14  to  22 

23 


24 

24 

101  to  119 

25,  26 

26 

26  to  29 

28,  29,  31,  32 

30 

30,31 

31,32 

32 

32,33 

33  to  41 

35 

36 

36  to  39 

38,39 

39 

39 

39,40 

40,41 

41,42 

42  to  44 

45,46 

46 

46,47 

47,48 

48  to  53 

51 

51.  52 


CONTENTS 


How  Supplies  Donated  may  be  Charged  to  Current  Expenses,  if 

desired    .  ...... 

Journal  Entries  to  be  made  by  Superintendent  in  opening  a  new 

set  of  books       ..... 
Superintendent's  Ledger  Accxiunts 

Trial  Balance 
Monthly  Report  of  Superintendent  to  Treasurer 
Superintendent's  Monthly  Statements  of  Revenue,  Expenses  and 

Statistics  ......... 

Superintendent's  Comparative  Month  and  To  Date  Statements 
Tbeasueke's  Accouxts  .... 

Treasurer's  Cash  Book 

Journal  and  Journal  Entries 
Journal  Entries  to  be  made  by  Treasurer  in  opening  a  new  set  of 

books        ..... 
Treasiirer's  General  Ledger  Accounts 
Trial  Balance. 

"  Income  Ledger  Accounts . 

Amortization  or  Accumulation  on  Bonds 
Treasurer's  Endowed  Bed  Ledger  Accounts 
Statistics 

Forms  used  in  computing  Statistics  concerning  Numbers  of  Patients 

Treated,  Days  Treatment,  Visits,  etc.,  referred  to  in  Schedule  6 
Hospital  Patients  Statistics        ....... 

Method  of  figuring  Cost  per  Patient  per  Day  or  per  Visit 

Out  Patient  Department  Statistics     ...... 

Social  Service  Department  Statistics  ..... 

Comparative  Statistical  Figures  for  a  Period  of  Months  or  Years 


52 

52,53 

54  to  58 

57 

59,  60 

59,  101 

I,  118,  119 

61  to  100 

61  to  64 

64  to  71 

70,71 

72  to  87 

87 

87  to  96 

97  to  99 

99,  100 


101  to  119 
101  to  108 
108 
108  to  115 
115  tolls 
118.  119 


Hospital 
Accounting  and  Statistics 


SCHEDULE  1 

Detailed  Statement  of  Cukrent  Revenue 

HOSPITAL  EARNINGS  (OR  OPERATING  EARNINGS): 

1917  1916 

Private  Room  Patients 

Board  of  Friends  of  Patients 

Semi-Private  Patients 

Ward  Patients 

Special  Nursing 

Operating  Room  Fees 

X-Ray  Service 

fDispensary 

tEmergency  Ward 

Pharmacy 

Ambulance  Fees 

Telephone  and  Telegraph . . .' 

Scrap  Material  Sold 

Miscellaneous 


Total  Hospital  Earnings 

OTHER  REVENUE  OR  INCOME: 

From  the  Public  Treasury 

•Donations  from  Individuals  to  meet  Current 

Expenses 

Donations  from   Churches   to  meet  Current 

Expenses 

From  The   United  Hospital  Fund  of   New 

York 

Donations,  Special 

Net    Receipts    from    Entertainments,    Fairs, 

Fetes,  etc 

•Legacies,  unrestricted 

Income  from  Investments  held  in  Endowed 

Bed  Fund 

Income   from   Investments   held   in   General 

Endowment  Fund 

Income  from  Investments  held  in  Other  Funds 

(enumerate)  the  income  of  which  is  to 

be  used  to  meet  Operating  Expenses, 

Schedule  2,  and  is  not  to  be  added  to 

the  principal 

Income  from  unrestricted  Investments 

Miscellaneous 

Total  other  Revenue  or  Income 


fOr  Out  Patient  Department. 

*The  amounts  shown  for  Unrestricted  Donations  or  Legacies  should  include 
the  value  of  investments  (not  including  accrued  interest)  given  to  the  Hospital 
without  restriction. 

NoTK. — It  may  be  found  preferable  to  credit  "Unrestricted  Legacies"  direct 
to  Endowment  Fund  or  to  a  General  Fund  and  not  to  consider  them  a  part  of 
Current  Revenue. 

2 


SCHEDULE  1— Continued 

APPROPRIATIONS  FROM  SPECIAL  FUNDS  TO  MEET  CURRENT 

EXPENSES: 

•(Show  appropriation  from  each  fund  sepa- 
rately.) 1917  1916 


Total  Appropriations  from  Special  Funds 
to  meet  Current  Expenses 

Grand  Total  Current  Revenue 

Excess  of  Current  Expenses  over  Current 
Revenue 

Total 


*NoTE. — Reference  should  be  made  to  some  page  or  pages  in  the  Annual  Re- 
port showing  briefly  the  purpose  for  which  each  special  fund  is  to  be  used. 


SCHEDULE  2 


Detailed  Statement  of  Current  Expenses  Including 
Operating,  Corporation  and  Other 


ADMINISTRATION  EXPENSES: 


1917 


1916 


Salaries,  Officers  and  Clerks 

Office  Expenses 

Stationery,  Printing  and  Postage . 

Telephone  and  Telegraph 

Legal  Expenses 

Miscellaneous 


Total  Administration  Expenses 

PROFESSIONAL  CARE  OF  PATIENTS 


Salaeies  and  Wages: 

Physicians 

Anesthetists 

Directress  of  Niu-ses,  Assistant  and  In- 
structors   

Nurses 

Special  Nurses 

Orderlies 

Special  Orderlies 

Ward  Employes 

Pharmacy  Employes 

Medical  and  Surgical  Supplies: 

Apparatus  and  Instruments 

tMedical  and  Surgical  Supplies, 

Alcohol,  Liquors,  Wines,  etc 

Clothing,  etc.,  for  use  of  Patients  in  Hos- 
pital   

Equipment  for  Nurses: 

Uniforms 

Books 

Instruments 

Uniforms,  etc.,  for  StafiF  and  Orderlies 

Pathological 
Department: 


•Dispensary: 

•Emergency  Ward: 

Social  Service 
Department: 

X-Ray  Service: 


j  Salaries  and  Labor. .  

(  Supplies 

(  Salaries  and  Labor. .  

(  Supplies 

j  Salaries  and  Labor. .  

(  Supplies 

J  Salaries 

(  Supplies 

j  Salaries  and  Labor.  

(  Supplies 

Total  Professional  Care  of  Patients ...  

*0r  Out-Patient  Department 

fNoTE. — As  "  Drugs  and  Druggist's  Sundries  "  make  up  a  large  part  of  "  Medical 
and  Surgical  Supplies"  it  may  be  found  desirable  to  subdivide  this  last  mentioned 

item  into  "Drugs  and  Druggist's  Sundries"  and  "Other  Medical  and  Surgical 
Supplies." 

4 


SCHEDULE  i—Cmtinued 

DEPARTMENT  EXPENSES: 

1917  1916 

(  Labor 

Ambulance:  1  Supplies 

{  Salaries  and  Labor. .  

ies 

j  Labor .  -         

Housekeeping:  "j  Supplies 

\  Labor 

ies 

i  Labor 


Training  School:        i  g„pp] 


Kitchen:  1  ^       r 

(  ouppln 


Laundry:  -j  „       ,. 

(  Supplies. 

Steward's  Department: 

Labor 

Provisions: 

Bread 

Milk  and  Cream 

Groceries 

Butter  and  Eggs 

Fruits  and  Vegetables .  . . 

Meat,  Poultry  and  Fish  . 
Total  Steward's  Department. 
Total  Department  Expenses . 


GENERAL  HOUSE  AND  PROPERTY  EXPENSES: 


*Electric  Lighting 

Fuel,  Oil  and  Waste 

Gas 

Ice 

Insurance 

*Maintenance,  Real  Estate  and  Buildings. . 

*Maintenance,  Machinery  and  Tools 

*Plumbing  and  Steamfitting 

Rent 

Miscellaneous 


Total  General  House  and  Property  Exps. 
Total  Operating  Expenses 


*  It  may  be  found  desirable  to  subdivide  the  items  marked  with  an  asterisk 
into  "Labor"  and  "Supplies"  so  as  to  show  how  much  the  pay-roll  charges  were 
for  each  account. 


SCHEDULE  i— Continued 


CORPORATION  EXPENSES 
1917 


1916 


Salaries,  Officers  and  Clerks 

Pensions 

Office  Expenses 

Stationery,  Printing  and  Postage 

Legal  Expenses 

Interest  on  Mortgages  or  Loans  Payable. 

Taxes 

Miscellaneous 


Total  Corporation  Expenses . 


CURRENT  EXPENSES  FROM   SPECL\L   FUNDS  FOR    STATED    PUR- 
POSES, OTHER  THAN  REGULAR  HOSPITAL  CURRENT  EXPENSES 

•(Show  expenditure  from  each  fund  separately.) 


Total  Current  Expenses  from  Special 
Funds  for  Stated  Purposes 

Grand  Total  Current  Expenses 

Excess  of  Current  Revenue  over  Current 
Expenses 

Total 


*NoTE. — Reference  should  be  made  to  some  page  or  pages  in 
showing  briefly  the  purpose  for  which  each  special  fund  is  used 


the  Annual  Report 


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SCHEDULE  4 


Comparative  Balance  Sheet 

As  of  September  30,  1917  and  1916 
CAPITAL  ASSETS: 


1917 
Hospital  Phopeeties  and  Equipment: 

Sites  and  Grounds 

Buildings 

Furniture  and  Fixtures . . 

Machinery  and  Tools . . . 

Apparatus  and  Instruments. 

Ambulances,  Live  Stock,  etc 

Miscellaneous 

tTotal 

Investments: 

Mortgages  Receivable.  • . 

Bonds 

Stocks 

Other  Investments 

Total  Investments.  . . . 


1916 


Increase         Decrease 


CURRENT  ASSETS 


Cash  in  hands  of  Treasurer .... 

Cash  in  hands  of  Superintendent 

Loans  and  Notes  Receivable  . . . 

Treasurer's  Accounts  Receivable 

Superintendent's  Accounts  Re- 
ceivable   

Accounts  Receivable  from  Pub- 
lic Treasury 

General  Material  on  Hand 

Advances: 

Interest  Purchased 

Prepaid  Insurance 

Other  Prepaid  Expenses 

Total  Current  Assets 

Grand  Total  Assets 

Deficit 

J  Total 


SCHEDULE  4 


Comparative  Balance  Sheet 

A»  of  September  30.  1917  and  1916 
CAPITAL  LIABILITIES: 


1917 


1916 


Increase       Decrease 


•  Capital  Account  (Hospital  Prop- 

erties and  Equipment) 

•Reserve  for  Depreciation  of  Hos- 
pital Properties  and  Equip- 
ment (if  any) 

*  Bonds  Outstanding  or  Mortgages 

Payable  on  Hospital  Prop- 
erty (if  any) 

tTotal 

Endowed  Bed  Fund  Account 

Partly  Endowed  Bed  Fund  Ac- 
count   

General  Endowment  Fund  Ac- 
coimt 

Other  Fund  Reserve  Accounts. . . 
(List  each  separately.) 


Total  Fund  Reserve  Accounts 

CURRENT  LIABILITIES 

Loans  and  Notes  Payable 

Audited  Vouchers  Unpaid  or  Ac- 
counts Payable 

Over-Payments  by  Patients 

Unpaid  Wages  of  Latest  Payroll 

Unclaimed  Wages  of  Previous 
Pay  Rolls 

Advance  Payments  by  Patients. . 

Total  Current  Liabilities 

Grand  Total  Liabilities 

Surplus 

JTotal 


*NoTE. — For  detailed  explanation  concerning  "Capital  Account"  and  "Re 
serve  for  Depreciation  of  Hospital  Properties  and  Equipment,"  and  "  Bonds  Out- 
standing or  Mortgages  Payable  on  Hospital  Property  "  see  pages  80  and  81. 

tThe  total  book  value  of  "Hospital  Properties  and  Equipment,"  as  shown 
under  the  heading  Capital  Assets  should  equal  the  total  of  the  amounts  shown  as 
"  Capital  Account,"  "  Reserve  for  Depreciation  of  Hospital  Properties  and  Equip- 
ment," and  Bonds  Outstanding  or  Mortgages  Payable  on  Hospital  Property  as 
shown  under  the  heading  Capital  Liabilities. 

t  These  totals  should  agree. 


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SCHEDULE  6 


COMPAHATIVE    STATISTICS    OF   PaTIENTS   TbEATED 

During  Years  ended  September  30,  1917  and  1916 
HOSPITAL  WARDS  AND  PRIVATE  ROOMS 

Male      Female 


Total 


Patients  in  Hospital  First  of  Year: 
In  Medical  Wards 


In  Surgical  Wards . 

In  Private  Rooms . 

Total 


Patients  Admitted  during  Ybab: 
To  Medical  Wards 


To  Surgical  Wards. 

To  Private  Rooms. 

Total 


Total  Patients  Treated  in  Hospital 

Wards  and  Private  Rooms  during  Year  : 


Patients  Discharged  During  Year: 
Cured 


Improved .  .  , 
Unimproved , 


Transferred  to  other  institutions. 


Died. 


Total 


1917 
1916 
1917 
1916 
1917 
1916 
1917 
1916 

1917 
1916 
1917 
1916 
1917 
1916 
1917 
1916 

1917 
1916 


1917 

1916 
1917 
1916 
1917 
1916 
1917 
1916 
1917 
1916 
1917 
1916 


Note. — For  description  and  illustrations  of  desirable  forms  for  use  in  com- 
puting statistics,  etc.,  of  patients  cared  for,  etc.,  as  shown  by  Schedule  6  on  pages 
11,  12,  and  13,  see  pages  101  to  119  inclusive  and  Exhibits  1  to  19,  inclusive. 

For  distinctive  purposes  previous  year's  figures  should  be  shown  in  italics  or  red. 

11 


12 


SCHEDULE  6 — Continued 


Patients  in  Hospital  End  of  Yeab: 
In  Medical  Wards 


Male      Female      Total 


In  Surgical  Wards . 

In  Private  Rooms  • 

Total 


1917 
1916 
1917 
1916 
1917 
1916 
1917 
1916 


Free    Endowed      Pay        Private 
Ward        Bed  Ward         Room 


Total 


Total  Patient 
Days  Treatment: 

Percentage 


Average  Patients  per  day 


1917 
1916 
1917 

1916 
1917 
1916 


Average  Days  per  Patient  in  Hospital 

Daily  average  Cost  per  Private  Room  Patient. 
Daily  Average  Cost  per  Ward  Patient 


1917 


1916 


OUT-PATIENT  DEPARTMENT 


Former    Patients    Treated,  who    have    been 
treated  in  some  previous  fiscal  year 


Male      Female      Total 


New  Patients  Treated. 
Total  Patients  treated. 


Visits  made 

Average  Visits  per  day . 


1917 

1916 

1917 

1916 

1917 

^"■^ 

■■"■ 

1916 

Free 

Pay 

Total 

1917 

1916 

1917 

1916 

1917 


1916 


Average  Visits  per  Patient. 
Average  Cost  per  Visit .... 
Surgical  Dressings  Made  .  . 
Prescriptions  Filled 


SCHEDULE  6—Cojitinued  IS 

AMBULANCE 

1917  1916 

AmbtJance  Calls  during  year ...  .... 

Average  Calls  per  day ....  .... 

Average  Cost  per  Ambulance  Call ....  .... 

Patients  Treated  by  Ambulance  Surgeon  in 

Emergency  Ward  and  Transferred ....  .... 

Patients  Treated  by  Ambulance  Surgeon  and 

left  at  place  of  call  or  transferred  direct  to 

other  Institutions  or  to  their  homes .... 

SUMMARY 

Total  Patients  Treated  at  the  Hospital  during 

year  in  all  Departments ....  .... 

Average  Patients  per  day  in  all  Departments  ....  .... 

Daily  Average  number  of  Employes  Boarded 

in  Hospital • .  • .  •  • . . 

Daily  Cost  per  capita  for  Provisions  for  all 

persons  supported .... 

SOCIAL  SERVICE  DEPARTMENT 

Former  Cases  Cared  for,  who  have  been  cared 

for  in  some  previous  fiscal  year .... 

New  Cases  Cared  for 

Total  Cases  Cared  for . .  •  • 

Visits  to  Homes  for  Social  Service .... 

Visits  to  Homes  of  Patients  for  Nursing  Care  

Visits  to  Ward  Patients  needing  Social  Service 

Care 

Visits  Made  at  Social  Service  OflSce •  •  •  • 

Total  Visits 

Former    Cases   Given   Material   Relief   who 

have  received  such  relief  in  some  previous 

fiscal  year .... 

New  Cases  Given  Material  Relief .... 

Total  Cases  Given  Material  Relief 

Cases  referred  to  Organizations  for  Material 

Relief  or  Employment 

Patients  sent  to  Convalescent  Homes  and 

Sanatoria •  •  •  • 

Patients  sent  to  Hospitals,  Homes  for  Incur- 
ables and  Aged .... 

Patients  sent  to  Fresh  Air  Homes .... 


INSTRUCTIONS   REGARDING    DISTRIBUTION    OF 

EXPENSES    INCLUDING    OPERATING, 

CORPORATION,  AND  OTHER 

ADMINISTRATION  EXPENSES 

1.  SAiiABiES,  Officers  and  Clerks 

This  account  includes  the  salaries  of  general  oflBcers  of  the 
Hospital  and  their  assistants  or  clerks,  whose  salaries  are  not 
directly  chargeable  to  any  department. 

This  account  should  not  include  salaries  of  officers  or  clerks, 
who  are  exclusively  engaged  with  the  management  of  the  corpo- 
ration, estate  or  sources  of  revenue  outside  of  the  ordinary  receipts 
of  the  hospital  proper.  If  certain  officers  or  clerks  are  partly 
engaged  in  this  manner,  a  proper  proportion  of  their  salaries 
should  be  charged  accordingly. 

2.  Office  Expenses 

This  account  includes  car  fares,  express  charges,  messenger 
service,  subscriptions  to  newspapers  and  periodicals,  office  furni- 
ture and  fixtures,  and  such  other  office  supplies  as  are  not  properly 
chargeable  to  any  other  subdivision  of  Administration  Expenses 
or  to  Corporation  Expenses. 

3.  Stationery,  Printing  and  Postage. 

This  account  includes  the  cost  of  printing  annual  reports, 
blank  books,  blank  forms,  paper,  stationery,  stationery  supplies, 
etc.,  used  in  the  general  work  of  the  hospital.  It  should  not 
include  expenditures  of  this  nature  made  for  corporation  purposes. 

The  following  is  a  list  of  the  more  important  items  which  may 
be  chargeable  to  this  account: 


Arm  resta 

Circulars 

Invoice  books 

Binders 

Copy  (impression)  books 

Legal  cap  paper 

Blank  cards 

Dating  stamps 

Letter  paper 

Blank  paper 

Envelopes 

Manifold  paper 

Blank  tablets 

Erasers 

Mimeographs 

Blotters 

Eyelet  punches. 

Mucilage 

Blotting  paper 

Eyelets 

Mucilage  brushes 

Calendars 

Hektographs 

Notices 

Carbon  paper 

Indexes 

Numbering  stamps 

Cardboard 

Ink 

Oil  paper 

Cards 

Inkstandi 

Orders 

14 


DISTRIBUTION  OF  EXPENSES 


15 


Paper 

Pins 

Shipping  tags 

Paper  baskets 

Postage 

Shorthand  books 

Paper  clips 

Printed  cards 

Sponge  cups 

Paper  cutters 

Printed  tablets 

Sponges 

Paper  fasteners 

Rubber  bands 

Telegraph  blanks 

Paper  files 

Rubber  stamps 

Tissue  (impression)  paper 

Paper  weights 

Rulers 

Twine 

Pencil  erasers 

Ruling  pens 

Typewriter  supplies 

Pencils 

Scrap  books 

Waste  baskets 

Penholders 

Sealing  wax 

Water  holders 

Pen  racks 

Seals 

Wrapping  paper,  etc 

Pens 

Shears 

4.  Telegraph  and  Telephone. 

This  account  includes  all  expenditures,  account  telegraph 
messages,  rent  of  telephones,  salaries  of  operators  or  maintenance 
of  telephones  and  telephone  lines. 

5.  Legal  Expenses. 

This  account  includes  all  fees  and  retainers  paid  for  services 
of  attorneys,  costs  of  suits  and  all  legal  and  court  expenses  in- 
curred in  the  operation  of  the  Hospital.  It  should  not  include 
expenditures  of  this  nature  made  for  corporation  purposes. 

6.  Miscellaneous. 

This  account  includes  such  other  Administration  Expenses  as 
are  not  directly  chargeable  to  any  of  the  foregoing  accounts,  or 
to  Corporation  Expenses. 

PROFESSIONAL  CARE  OF  PATIENTS 


7.  Salaries  and  Wages. 

This  account  includes  the  salaries  and  wages  of  employes 
imder  the  various  headings  named. 

8.  Medical  and  Surgical  Supplies. 

This  account  includes  the  cost  of  apparatus  and  instruments, 
medical  and  surgical  supplies,  and  alcohol,  liquors,  wines,  etc., 
purchased  for  the  general  use  of  the  Hospital,  not  specifically 
chargeable  to  any  department. 

It  would  not,  however,  include  the  purchase  of  new  and  addi- 
tional apparatus  and  instruments  in  large  quantities,  which 
should  be  charged  to  capital  account,  under  the  heading  provided 
therefor. 

9.  Clothing,  etc.,  for  Use  of  Patients  in  Hospital. 
This  account  includes  the  cost  of  clothing,  slippers,  tooth- 


16  DISTRIBUTION  OF  EXPENSES 

brushes,  etc.,  for  patients'  use  while  in  the  hospital.  If  any  such 
articles  are  made  in  the  hospital  the  cost  of  the  material  used  and 
labor  employed  should  be  charged  to  this  account. 

10.  Equipment  for  Nurses. 

This  account  includes  the  cost  of  uniforms,  books  and  instru- 
ments, if  furnished  to  the  nurses  by  the  Hospital. 

If  uniforms,  books  and  instruments  are  purchased  by  the 
Hospital,  to  be  paid  for  later  by  the  nurses,  they  should  be  charged 
to  the  General  Material  Accoimt,  and  that  account  should  be 
credited  when  these  are  paid  for  by  the  nurses. 

11.  Uniforms,  etc.,  for  Staff  and  Orderlies. 

This  account  includes  the  cost  of  uniforms,  operating  gowns, 
etc.,  for  staff  and  orderHes.  If  any  such  articles  are  made  in  the 
hospital  the  cost  of  the  material  used  and  labor  employed  should 
be  charged  to  this  account. 

12.  Pathological  Department. 

(a)  Salaries  and  Labor.  This  account  includes  the  salaries 
and  wages  of  physicians,  assistants,  and  any  other  employes  in 
this  department,  including  amounts  paid  for  cost  of  labor  in 
making  repairs  or  maintaining  the  equipment  of  this  department. 

(b)  Supplies.  This  account  includes  the  cost  of  all  apparatus 
and  instruments,  medical  and  surgical  supplies,  and  any  other 
supplies  whatsoever,  which  are  properly  chargeable  to  this  de- 
partment; also,  the  cost  of  any  materials  used  in  making  repairs 
or  maintaining  the  equipment  of  this  department. 

13.  Dispensary  or  Out-Patient  Department. 

(a)  Salaries  and  Labor.  This  account  includes  the  salaries 
and  wages  of  physicians,  assistants,  nurses,  and  any  other  em- 
ployes in  this  department. 

(6)  Supplies.  This  account  includes  the  cost  of  all  apparatus 
and  instruments,  medical  and  surgical  supplies,  and  any  other 
supplies  whatsoever,  which  are  properly  chargeable  to  this  depart- 
ment. 

14.  Emergency  Ward  or  Out-Patient  Department. 

(a)  Salaries  and  Labor.  This  account  includes  the  salaries 
and  wages  of  physicians,  assistants,  nurses,  and  any  other  em- 
ployes in  this  department. 

(6)  Supplies.  This  account  includes  the  cost  of  all  apparatus 
and  instruments,  medical  and  surgical  supplies,  and  any  other 
supplies  whatsoever,  which  are  properly  chargeable  to  this  depart- 
ment. 


DISTRIBUTION  OF  EXPENSES  17 

15.  Social  Service  Department, 

(a)  Salaries.  This  account  includes  the  salaries  of  nurses 
or  other  employes  in  this  service. 

(6)  Supplies.  This  account  includes  the  cost  of  all  medical 
and  surgical  supplies,  food,  clothing,  or  any  other  supplies  pur- 
chased for  this  service  for  use  of  patients,  etc. 

16.  X-Ray  Service. 

(a)  Salaries  and  Labor.  This  account  includes  the  salaries 
and  wages  of  physicians,  operators  and  any  other  employes  in 
this  service. 

(b)  Supplies.  This  account  includes  the  cost  of  apparatus 
and  supplies  which  are  properly  chargeable  to  this  service. 

DEPARTMENT  EXPENSES 

17.  Ambulance. 

(a)  Labor.  This  account  includes  the  wages  of  all  employes  in 
this  department;  also  the  cost  of  any  other  labor  in  connection  with 
making  repairs  or  maintaining  the  equipment  of  this  department. 

(b)  Supplies.  This  account  includes  the  cost  of  all  equip- 
ment and  supplies  of  any  nature  which  are  properly  chargeable 
to  this  department;  also,  the  cost  of  any  material  used  in  making 
repairs  or  maintaining  the  equipment  of  this  department.  It 
should  not  include,  however,  new  and  additional  equipment, 
such  as  ambulanceSv  live  stock,  etc.,  as  it  is  considered  more  proper 
to  charge  such  new  equipment  to  capital  account,  under  the  heading 
provided  therefor. 

18.  Training  School. 

(a)  Salaries  and  Labor.  This  account  includes  the  salaries 
and  wages  of  officers,  instructors,  and  any  other  employes  which 
are  chargeable  exclusively  to  the  cost  of  operating  and  maintain- 
ing the  training  school,  and  which  can  not  properly  be  charged 
to  any  other  account. 

(6)  Supplies.  This  account  includes  the  cost  of  supplies  and 
materials  which  are  directly  chargeable  to  the  cost  of  operating 
and  maintaining  the  training  school  exclusively,  but  does  not 
include  the  cost  of  supplies  for  housekeeping,  kitchen,  laundry, 
steward's  department,  and  general  house  and  property  expenses 
in  connection  with  the  training  school,  which  should  be  charged 
under  their  respective  headings  elsewhere,  together  with  other 
expenses  of  similar  character  for  the  general  hospital,  as  it  does 
not  seem  desirable  to  further  subdivide  the  training  school  account. 


18  DISTRIBUTION  OF  EXPENSES 

19.  Housekeeping. 

(a)  Labor.  This  account  includes  the  salaries  and  wages  of 
the  housekeeper  and  all  persons  employed  in  this  department, 
including  waitresses,  chambermaids,  scrubwomen,  porters,  etc.; 
also,  all  persons  employed  in  making  and  maintaining  house- 
keeping supplies  and  in  cleaning,  etc.,  chargeable  to  the  general 
hospital  and  training  school,  and  not  chargeable  to  any  other 
department. 

(&)  Supplies.  This  account  includes  the  cost  of  furniture 
and  fixtures,  such  as  beds,  bedding,  chairs,  tables,  tableware, 
linen,  and  all  other  housekeeping  supplies.  It  also  includes  the 
repairs  of  same.  It  should  not  include,  however,  large  quantities 
of  new  and  additional  furniture,  as  it  is  considered  more  proper  to 
charge  these  to  capital  account,  under  the  heading  provided 
therefor. 

20.  Kitchen. 

(a)  Labor.  This  account  includes  wages  and  labor  of  all 
persons  employed  in  this  department,  in  connection  with  the 
preparation  and  general  distribution  of  all  food. 

(&)  Supplies.  This  account  includes  the  cost  of  all  kitchen 
utensils,  fuel  used  in  the  kitchen  range  and  other  supplies  and 
materials  chargeable  to  the  operation  and  maintenance  of  the 
kitchen,  not  including,  however,  provisions  mentioned  under  the 
heading  of  steward's  department. 

21.  Laundry. 

(a)  Labor.  This  account  includes  the  wages  of  employes 
engaged  in  this  department  or  the  cost  of  laundry  work  done  out- 
side. It  also  includes  the  cost  of  any  labor  in  connection  with 
repairs  or  maintenance  of  equipment  of  this  department. 

(&)  Supplies.  This  account  includes  the  cost  of  all  supplies  used 
in  this  department,  including  the  materials  used  in  connection  with 
operating  and  maintaining  the  equipment  of  this  department. 

22.  Steward's  Department. 

(a)  Labor.  This  account  includes  the  wages  of  all  persons 
employed  in  receiving,  storing  and  distributing  the  supplies  of 
this  department. 

(6)  Provisions. 

Bread.— This  account  includes  the  cost  of  all  bread,  cake, 
pastry,  etc.,  purchased. 

Milk  and  Cream. — This  account  mcludes  the  cost  of  all  milk, 
cream,  cheese  and  ice  cream  purchased. 


DISTRIBUTION  OF  EXPENSES  10 

Groceries. — ^This  account  includes  the  cost  of  all  groceries, 
canned  goods,  flour,  dried  fruit,  etc. 

Butter  and  Eggs. — ^This  account  includes  the  cost  of  all  butter 
and  eggs. 

Fruits  and  Vegetables. — ^This  account  includes  the  cost  of  all 
fresh  fruits  and  fresh  vegetables. 

Meat,  Poultry  and  Fish. — ^This  account  includes  the  cost  of 
all  meat,  whether  fresh,  dried  or  smoked,  and  of  poultry,  game, 
fish  and  all  sea  food. 

GENERAL  HOUSE  AND  PROPERTY  EXPENSES 

23.  Electric  Lighting. 

This  account  includes  the  cost  of  all  labor,  supplies  and  ma- 
terials used  in  connection  with  operating  and  maintaining  the 
electric  Hghting  plant,  not  including,  however,  the  cost  of  main- 
taining machinery  used  in  connection  with  same,  which  is  charge- 
able to  maintenance,  machinery  and  tools.  It  includes  the  cost 
of  maintaining  electric  lamps,  fixtures  or  wiring,  but  does  not 
include  the  cost  of  operating  steam  plant  or  dynamos,  which  is 
chargeable  to  maintenance,  machinery  and  tools.  This  account 
of  electric  lighting  includes  the  cost  of  any  electric  light,  if  fur- 
nished from  outside. 

24.  Fuel,  Oil  and  Waste. 

This  account  includes  the  cost  of  all  fuel,  oil  and  waste  used 
in  connection  with  operating  and  maintaining  the  power,  lighting 
and  heating  plant,  but  does  not  include  the  cost  of  fuel  used  in  the 
kitchen  or  laundry  range. 

25.  Gas. 

This  account  includes  the  cost  of  all  gas. 

26.  Ice. 

This  account  includes  the  cost  of  all  ice. 

(If  Refrigerating  Plant  is  used,  indicate  by  foot-note.) 

27.  Insurance. 

This  account  includes  the  cost  of  all  insurance  for  account  of 
the  hospital,  except  fidelity  insiu*ance,  which  should  be  charged  to 
Miscellaneous  Administration  expenses. 

28.  Maintenance  Real  Estate  and  Buildings. 

This  account  includes  the  cost  of  all  labor  and  materials  used 
in  connection  with  repairs  and  maintenance  of  real  estate  and 
buildings  in  the  hospital  group.    It  includes  the  cost  of  repairs 


20  DISTRIBUTION  OF  EXPENSES 

to  fences,  sidewalks,  and  the  cost  of  keeping  sidewalks  and  grounds 
in  good  order,  shoveling  snow,  etc. 

This  account  should  not  be  charged  with  repairs  and  renewals 
of  furniture  and  fixtures  such  as  beds,  bedding,  chairs,  tables, 
tableware,  etc.,  which  are  chargeable  to  housekeeping  supplies. 

This  account  does  not  include  the  cost  of  new  and  additional 
real  estate  and  buildings.  It  is  thought  more  proper  to  charge 
the  cost  of  these  to  capital  account,  under  the  headings  provided 
for  sites  and  grounds  or  buildings. 

29.  Maintenance,  Machinery  and  Tools. 

This  account  includes  the  cost  of  all  labor  or  materials  used 
in  connection  with  repairs,  maintenance  and  renewals  of  boilers, 
stationary  engines,  dynamos,  pumps,  elevators  and  other  machinery, 
including  the  shafting,  belting  and  other  appliances  for  running 
machinery  and  all  tools  and  fixtures  used  in  connection  therewith. 

It  includes  the  wages  of  engineers,  firemen,  elevator-men,  etc., 
not  directly  chargeable  to  other  accounts. 

This  account  should  not  include  the  cost  of  expensive  new 
machinery  and  tools,  except  in  so  far  as  these  replace  old  machinery 
and  tools.  It  is  considered  that  new  additional  machinery  and 
tools  are  more  properly  chargeable  to  this  heading  imder  capital 
account. 

30.  Plumbing  and  Steamfitting. 

This  account  includes  the  cost  of  all  labor  and  materials  used 
in  connection  with  repairs  and  renewals  of  all  water,  gas  or  steam 
pipes  and  fittings. 

31.  Rent. 

This  account  includes  the  cost  of  rental  of  buildings  used  in 
connection  with  hospital  work. 

32.  Miscellaneous. 

This  account  includes  the  cost  of  any  labor  and  materials 
chargeable  to  general  house  and  property  expenses,  not  included 
in  any  of  the  headings  already  provided  for. 

CORPORATION  EXPENSES 

33.  Salaries  Officers  and  Clerks. 

This  account  includes  salaries  of  officers  and  clerks,  who  are 
exclusively  engaged  with  the  management  of  the  corporation, 
estate  or  other  sources  of  revenue  outside  of  the  ordinary  receipts 
of  the  hospital  proper. 

If  certain  officers  or  clerks  are  partly  engaged  in  this  manner 


DISTRIBUTION  OF  EXPENSES  21 

a  proper  proportion  of  their  salaries  should  be  charged  accordingly. 

34.  Office  Expenses. 

This  account  includes  such  corporation  expenses  as  car  fares, 
express  charges,  messenger  service,  subscriptions  to  newspapers 
and  periodicals,  rent  of  safe  deposit  box,  office  furniture  and 
fixtures  and  such  other  office  supplies  as  are  not  properly  charge- 
able to  any  other  subdivision  of  Corporation  Expenses  or  Admin- 
istration Expenses. 

35.  Stationery,  Printing  and  Postage. 

This  account  includes  expenditures  of  this  nature  for  corpora- 
tion purposes  and  for  soliciting  Donations,  etc. 

36.  Legal  Expenses. 

This  account  includes  expenditures  of  this  nature  made  for 
corporation  purposes. 

37.  Interest  on  Mortgages  and  Loans  Payable. 
This  heading  explains  itself. 

38.  Taxes. 

This  account  includes  all  taxes,  if  any,  paid  on  property  used 
for  hospital  purposes. 

Taxes  paid  on  property  held  for  investment  and  not  used  for 
hospital  purposes  should  be  debited  to  income,  if  any,  from  such 
investment.  If  there  is  no  income  from  such  investment,  these 
expenses  may  be  debited  to  the  capital  account  of  such  invest- 
ment, if  the  prospective  value  of  the  investment  seems  to  justify 
such  action.  Otherwise  such  taxes  may  be  charged  as  a  part  of 
Corporation  Expenses. 

39.  Miscellaneous. 

To  this  account  should  be  charged  any  other  corporation 
current  expenses  not  properly  chargeable  to  any  of  the  other 
headings  provided,  including  petty  current  expenses  paid  on 
account  of  investments. 

Current  expenses  other  than  petty  current  expenses  paid  on 
property  held  for  investment  and  not  used  for  hospital  purposes 
should  be  debited  to  income,  if  any,  from  such  investment.  If 
there  is  no  income  from  such  investment,  these  expenses  may  be 
debited  to  the  capital  account  of  such  investment  if  the  prospective 
value  of  the  investment  seems  to  justify  such  action.  Otherwise 
such  expenses  may  be  charged  as  a  part  of  Corporation  Expenses. 

40.  Current   Expenses   from   Special   Funds   for   Stated 
Purposes,  other  than  regular  Current  Hospital  Expenses. 

(Show  expenditure  from  each  fund  separately.) 
This  account  explains  itself. 


£2  DISTRIBUTION  OF  EXPENSES 

CAPITAL  EXPENDITURES 

41.  To  Sites  and  Grounds  Account,  Buildings  Account,  Furni- 
ture and  Fixtures  Account,  Machinery  and  Tools  Account,  Appa- 
ratus and  Instruments  Account,  or  Ambulances,  Live  Stock,  etc.. 
Account,  under  the  heading  "Capital  Expenditures"  (Schedule 
3)  may  be  charged  the  cost  of  any  such  new  and  additional  Hos- 
pital Property  or  Equipment  to  such  extent  as  it  does  not  renew 
or  replace  property  or  equipment  already  in  use  and  to  such  ex- 
tent as  it  increases  the  value  or  efficiency  of  the  assets  concerned. 
Ordinarily  it  would  hardly  seem  worth  while  to  charge  small 
expenses  of  such  nature  to  Capital  Account  unless  the  aggregate 
amount  of  such  small  expenditures,  in  the  opinion  of  the  hospital 
officials  concerned,  seemed  to  justify  such  action. 


APPENDIX 

Advantages  op  Uniform  and  Intelligent  Hospital  Financial 
Reports  and  Statistics 

Some  advantages  to  hospitals  or  other  similar  institutions  of 
adopting  financial  and  statistical  reports  in  form  similar  to  that 
recommended  in  this  book  are  as  follows: 

First — It  provides  an  intelligent  and  accurate  system  of 
accounting,  which  has  proved  entirely  satisfactory  to  a  number  of 
different  institutions,  and  is  recommended  by  many  practical 
hospital  experts  and  by  certified  public  accountants. 

Second. — The  system  of  bookkeeping  herein  recommended 
involves  less  work,  considering  results  obtained,  than  any  other 
system  of  accounting  heretofore  recommended  for  general  adop- 
tion by  hospitals. 

Third. — Vv'here  a  uniform  system  of  accounts  and  statistics 
is  used  by  different  hospitals,  comparisons  can  be  made  on  a  fair 
and  intelligent  basis.  These  comparisons  are  of  much  value  and 
interest  not  only  to  officials  of  hospitals,  but  also  to  the  public 
who  may  be  interested  in  the  work  and  results  obtained  by  such 
institutions. 

Fourth. — ^As  many  hospitals  and  other  similar  institutions  are 
largely  maintained  by  contributions  from  the  public,  such  insti- 
tutions should  inform  the  public  by  means  of  comprehensive  and 
uniform  financial  reports  and  statistics  as  to  assets  and  liabilities, 
revenue  and  expenses,  work  accomplished  and  cost  of  same. 
Where  such  information  is  furnished  in  some  uniform  manner 
it  is  much  more  easily  understood  by  all  interested,  than  if  each 
different  institution  makes  reports  in  some  manner  peculiar  to 
itself  with  which  the  public  is  not  familiar. 

Object  of  this  Appendix 

In  order  to  explain  as  clearly  as  possible  to  those  who  are  not 
accountants  just  what  forms  and  account  books  may  be  used  and 
how  the  various  entries  and  statements  may  be  made  in  keeping 
accounts  in  accordance  with  this  system,  there  are  given  in  this 
Appendix  descriptions  and  illustrations  of  the  forms  and  entries 
used  by  The  Presbyterian  Hospital  in  the  City  of  New  York. 

23 


24  DOUBLE  ENTRY  BOOKKEEPING 

Applicability  of  this  System  of  Accounting  to  all  Soetb 
OF  Chabitable  Institutions 

With  slight  modifications  to  suit  varying  conditions,  the  sys- 
tem of  accounting  described  herein  should  be  applicable  to  any 
hospital,  large  or  small.  In  the  case  of  small  institutions,  many 
of  the  subdivisions  shown  on  the  schedules  and  elsewhere,  if  not 
needed,  may  be  omitted  entirely,  which  would  simplify  the  state- 
ments and  accounts.  For  very  large  hospitals  or  for  those  doing 
special  work,  it  may  be  desirable  to  have  some  additional  or 
different  subdi'V'isions  than  those  shown  in  the  Schedules,  but 
the  method  of  keeping  the  accounts,  and  the  general  arrangement 
of  the  forms  and  statements  should  be  about  the  same  in  any 
case.  The  same  system  of  accounting  with  proper  modifications 
of  details  could  likewise  be  applied  in  keeping  the  accounts  of 
any  other  kind  of  charitable  institution. 

Double  Entby  System  of  Bookkeeping 

Under  the  double  entry  system  of  bookkeeping,  now  generally 
used  by  up-to-date  corporations,  any  expense  incurred  or  paid, 
or  any  loss  or  depreciation  charged  must  be  debited  to  some 
General  Ledger  Account,  and  credited  to  another,  and  any  reve- 
nue, receipt  or  profit  accrued  or  received  must  be  credited  to 
some  General  Ledger  Account  and  debited  to  another.  If  the 
debit  sides  of  all  these  Ledger  Accounts  are  then  totaled,  the 
results  should  equal  the  sum  of  all  the  totals  on  the  credit  side  of 
all  Ledger  Accounts. 

In  these  same  General  Ledger  Accounts,  if  the  difference  only 
in  the  totals  of  the  entries  on  the  debit  side  and  the  credit  side, 
or  the  balance  of  each  account  is  entered  upon  what  is  called  a 
Balance  Sheet  on  the  debit  side  of  the  Balance  Sheet,  opposite 
accounts  in  which  the  debits  exceed  the  credits,  and  on  the  credit 
side  of  the  Balance  Sheet,  opposite  accounts  in  which  the  credits 
exceed  the  debits,  the  total  of  all  these  balances  on  the  debit  side 
of  the  Balance  Sheet  should,  of  course,  agree  with  the  total  of  all 
the  balances  on  the  credit  side  of  the  Balance  Sheet,  if  the  entries 
have  been  correctly  made  and  footed. 

If  these  totals  do  not  agree,  it  is  evident  some  error  has  been 
made,  which  must  be  found  and  rectified. 

The  advantages  of  this  double  entry  system  of  accounting  are 
that  it  enables  its  users  to  easily  and  accurately  test  the  correctness 


SUPERINTENDENT'S  VOUCHERS  25 

of  the  entries  and  footings  made  on  the  books,  and  to  determine 
the  proper  debit  or  credit  balance  of  any  General  Ledger  Account. 

SUPERINTENDENT'S  ACCOUNTS 

The  following  paragraphs  describe  the  various  forms  used  in 
the  Superintendent's  office  of  the  Presbyterian  Hospital  and  the 
manner  in  which  entries  are  made  to  the  accounts  referred  to. 

Vouchers 

Vouchers  are  used  for  convenience  to  provide  a  uniform  size 
and  kind  of  blank  on  which  to  describe  each  respective  bill,  as 
illustrated  on  Exhibit  A.  They  also  bear  suitable  certificates 
for  clerks  and  officials  to  sign,  stating  that  all  extensions,  additions 
and  calculations  in  the  account  have  been  examined  and  found 
correct,  and  that  the  account  has  been  properly  entered  on  the 
books  and  has  not  been  previously  entered  or  paid,  and  also  that 
the  account  is  correct  and  has  been  incurred  for  the  benefit  of  the 
Hospital. 

Provision  is  also  made  so  that  the  party  in  whose  favor  a 
voucher  is  made  may  sign  his  receipt  thereon  of  the  amount  called 
for  by  the  voucher. 

On  the  back  of  each  voucher  it  is  found  convenient  to  print 
all  of  the  headings  adopted  in  the  classification  of  expenses,  to 
which  any  expense  paid  by  voucher  might  be  charged,  not  includ- 
ing pay-roll  expenses,  as  a  similar  provision  can  be  made  on  the 
back  of  some  of  the  pay-roll  sheets,  so  that  distribution  of  pay- 
rolls to  the  proper  headings  can  be  recorded  on  the  back  of  the 
last  sheet  of  the  pay-roll  in  the  same  way,  as  the  pay-roll  is  treated 
as  one  voucher. 

A  clear  record  may  thus  be  kept  on  each  voucher  and  in  a 
Voucher  Register  showing  to  what  account  or  accounts  each 
voucher  has  been  charged. 

Vouchers  should  be  consecutively  numbered,  to  correspond 
with  the  number  given  in  the  Voucher  Register.  It  is  suggested 
that  each  voucher  be  dated  with  the  date  that  the  Cash  Book 
shows  it  has  been  paid.  After  being  paid  vouchers  should  be  filed 
for  reference  in  consecutive  numerical  order,  so  they  may  be 
easily  referred  to  if  desired. 

The  vouchers  only  are  usually  sent  out  of  the  Superintendent's 
office  between  the  10th  and  15th  of  each  month,  when  bills  for 
the  preceding  month  are  ready  for  payment,  having  been  approved 


26  SUPERINTENDENT'S  PAY-ROLLS 

by  the  Superintendent  and  some  member  of  the  Board  of  Man- 
agers. Where  special  discounts  are  offered  for  more  prompt 
payment  vouchers  may  be  paid  more  promptly.  As  the  Su- 
perintendent has  a  complete  record  of  each  voucher  on  his 
Voucher  Register  and  also  has  in  his  office  the  original  bills  to 
which  each  voucher  refers,  the  extra  labor  and  expense  of  making 
separate  checks  is  not  considered  necessary.  Considerable  labor 
will  be  saved  if  vouchers  are  made  in  the  form  of  and  used  as  a 
check,  as  illustrated  on  Exhibit  A.  When  such  vouchers  are 
mailed  in  payment  of  bills,  they  are  almost  invariably  receipted 
and  returned  promptly  to  the  Hospital  through  the  bank  at  which 
they  are  payable. 

Expenses  Paid  by  Vouchers  through  the  Superintendent's 

Office 

It  will  simplify  the  keeping  of  accounts  if  all  current  expenses 
indicated  on  Schedule  2  and  capital  expenditures  indicated  on 
Schedule  3  are  paid  by  vouchers  through  the  Superintendent's 
office. 

Large  bills  for  prepaid  insurance  may  be  paid,  when  rendered, 
direct  by  the  Treasurer  and  apportioned  monthly  to  Operating 
Expenses,  as  explained  in  footnote  under  heading  Prepaid  Insur- 
ance Account  on  page  79. 

Expenditures  for  assessments,  which  may  increase  the  value 
of  property  held  in  investment  account  or  for  additions  and  better- 
ments to  property  held  in  investment  account,  should  be  paid 
direct  by  Treasurer's  check  and  charged  on  the  Treasurer's  books 
to  the  investment  account  concerned  to  the  extent  that  such 
expenditures  increase  the  value  of  the  investment  concerned. 

Taxes  and  current  expenses,  other  than  petty  current  expenses, 
on  property  held  for  investment  may  be  paid  direct  by  Treasurer's 
check  and  charged  against  income,  if  any,  of  the  investment 
concerned.  If  there  is  no  income  it  may  be  found  preferable  to 
charge  such  expenses  to  capital  account  of  the  investment  con- 
cerned, if  the  prospective  value  of  the  property  seems  to  justify 
so  doing.  Otherwise  such  expenses  may  be  paid  by  Superinten- 
dent's voucher  and  charged  as  a  part  of  Corporation  Expenses. 

Pay-Rolls 

Sample  pay-roll  sheets  are  illustrated  on  Exhibits  B  and  Bl. 
The  distribution  of  pay-roll  expenses  is  printed  on  the  back  of 


EXHIBIT    A 

■APRIL  ISTH 19DS         lICCCtbCD  Of  THE  PRESBYTERIAN  HOSPITAL  IN  THE  CITY  OF  NEW  YORK. 

■Xi\E  HUNDRED  TWENlX^SJJC^KD-^8Aoai^;:LilJC.-i;_:^L^^  :;  v:  ::  .-v  :;  v.-DoUan,  ^■526 .a8 

in  full  for  th<  following  account; 


(Sign  here) 


<^<24^.  y.  J%u^^._ 


^>- READ    IHIS.-'^' '--''"'■'' -"!;:,              ,,           -,     ..;::.:;;                      ,'.■■;    .  ■        '.    '-> -^^.o^nv ., 

MARCH 

■) 

^*''   GLASS    SLIDES,    SPECIMEN   GLASSES   AND   TEST   TlIRfS 

. 

q 

04 

. 

14 

OPFRATIWr.    TAP|F     AMfl     c;i|Rr5|niL      |MC;XRIJHFMT<; 

4I1 

8 

?7 

?^ 

rATGHT,     PUSS    RASINS,     RIIRRFR    <^HFFT1NR    ANn    TARI  F    -^(^f- 

s 

6 

? 

7? 

31 

REPAIRING.    SHARPENING    AND  REPLATING    INSTRUMENTS 

1 

6 

^^ 

•i 

? 

6 

48 

EXHIBIT      A 

AnTIIAl    «;I7F   riF  THis'vftiirHFR   ft  y   q-i/a 

' 

as  per  bills  of  dates  shoisjn. 

^ 

~) 

I  cerul/  iQai  1  Have  ejcamineO  all  exUnaions,  additions  »nd  calculations  in 
lh«  above  account  and  find  thetn  correct,  and  have  entered  the  account  on  the 
books  of  ihejjpepital  ancj  the  same  has  not  been  previously  entered  orpaid. 

I  cert.iy  that  the  above  account  is  correct 
and   has  been  incurred   fa/Jbe^enefit  of 

v^'                      H    SdDennlcndeTiL 

Approved:                       >    / 

I 

THE  PRESBYTERIAN  HOSPITAL 
IN  THE  CITY^QF  NEW.  YORK, 


/or  the  above  account. 


New  York  City,  N.  r.,A-PELLL,_1^H. 


To  MR__CHABLE  S_T_iu.D  Ali_S^ 


^dyrw_55iLJiEAtLSJB£EX^&R0_0jaYN._N.,_Y_. 


-Dr. 


This  voucher,  when  sl{ncd  by  the  proper  oltlcfals  of  the  Hospital,  Is  payable  In  current  funds  at  the  FIDELITY  BANK, 

NEW  YORK  CITY,  when  receipted  In  accordance  with  the  direclions  above,  printed  In  red  Ink. 

i«>.Mi         PLEASE  COLLECT  THIS  VOUCHER   PROMPTLY  SO  THAT  THE   HOSPITAL  MAY  BE  ASSURED  OF  ITS  RECEIPT. 


NOTE:  The 'advantage  of  having  a  voucher  printed  as  indicated  above  is  that  it  may  be  folded  once  and 
placed  in  an  outlook  envelope  so  that  the  name  and  address  of  the  party  in  whose  favor  the  voucher  is  made,  as 
shown  on  the  voucher,  serves  as  the  mailing  address,  thereby  avoiding  additional  labor. 

By  the  sample  voucher  it  will  be  noted  that  provision  has  been  made  for  approval  by  some  member  of  the  Board 
of  Managers.  The  President  or  Executive  Committee  might  from  time  to  time  designate  the  manager,  whose 
duty  it  would  be  to  approve  vouchers,  if  found  correct.  Such  rotation  of  responsibility  might  increase  the  interest 
of  the  managers  and  make  them  more  familiar  with  the  actual  workings  and  expenditures  of  the  Hospital. 

It  also  increases  the  likelihood  of  valuable  suggestions  as  to  improving  the  management. 

In  case  it  is  desired  to  have  a  member  of  some  committee  also  approve  such  vouchers  as  concern  his  particular 
committee,  additional  endorsements  may  be  made  accordingly. 

It  would,  of  course,  be  optional  with  the  hospital  authorities  as  to  whether  they  instruct  the  bank  to  honor 
vouchers  when  signed  only  by  the  Superintendent  or  Assistant  Superintendent  and  by  the  Chief  Clerk  or  Assistant 
Chief  Clerk  or  whether  the  voucher  must  also  bear  the  signature  of  any  other  hospital  oflScial.  " 


EXHIBIT  B 


VOUCHEB    ^JUL..                ■■            AMOUNT   ^MlJl 

PAY    ROLL   DISTRIBUTION 

Ailminlsiratlon: 

/  ! 

'uri' 

■/  /  ir, 

■ 

Frotessionol  Care  ol  Patients: 

^5521 

N-,.r  <.<■<. 

T 

(iUW. 

\) 

i,  1  -.w 

lit  t    ,\,.< 

'-  i  /.'J 

!^> 

1 1  -o 

W.nl   I„,^I,.K^ 

1- 

^,,  ^  ^   ,.  _j^    f^.,  ^^^^ 

"    n,  ,r   ,„  . 

1         ,          ■          T,     .        ..    ,          tv        T^.     ..         >T< 

'  /  /// 

?4?Z 

ZZ22 

"              v!'','J',.. :     .■ i       U 

7>/>, 

"*^ 

,.    ,      r,   rk f     -^.   .    ^  ..■■ 

i,A 

■^ 

■^ 

Departments: 

f 

1^ 

r         ^,     ,        '     ■' 

J 

J        , 

J 

7  /  f  " 

1 

eoUCATIONAt  WOHB   (Not  ctiargeable  to  otLfr  accoiinl^t 

General  tlouse  and  Property; 

:/- 

.^ 

\t        (    .     .  -    ■    M  ,   III.,    fv    1..  I    T    .  K         '                                                 II' 

CJ 

N^ 

Corporation: 

„ 

^  ^  "^ 

-^ 

Current  tiapena«a  from  Special  Fonda; 

1    1 

t^pltal  Eapenuitu^a: 

/m/AiyuiAf  \  yiHHJ/ 

IfTTTT 

^,  r»-^ 

Total 

</. 

J  ■'  -^r; 

EXHIBIT  Bi     Actual  aisa  ll«x  17» 
Illustrating  style   of  pay  roll  where  addreeaograph 
or  other  listing  machine   Is  used. 

THE    PRESBYTERIAN    HOSPITAL 

Vouehsr  JVo^A^l.^         Sheet  /fo./^^ 


Amount  traughi  forwar 

KITCHEN 
LEE, JOSEPHINE 
SHULTZ, HENRY 
GE.N30N, HILDA 
WEJL. LOUIS 
SWEENEY. AGNES 
QASEY.HARY 
DONNER.ANNA 
CALLAHAN. NORA 
JONES. WILL  I  AM 
CLRTISS. ALICE 


S75.  MO. 
$BO,MO. 
$60. HO. 
S35.MO. 
S30.M0. 
$23. MO. 
$25. MO. 
$25. MO. 
£35. MO. 
$23. MO. 


FIREM 

275 

FIREM 


CARP 

287 
OILER 
2S9 
CARP 
290 
PLUM 

291 
ELEV 

293 
ELEV 

296 


ENGINEERS  DEPT 

P'RENT  ICE.  JOHN  B.  $150. MO. 

BANKS. GEORGE      $125. MO. 

BRENNEN. JOSEPH    SllO.MQ. 

ANDERSON. WILLIAM  $100. MO. 
DUA-NE'.  ROBERT      S85.M0.. 
WILLIAMS, HARRY  K.$75.M0.. 

FANNING. THOMAS    $90. HO. 

KENNEDY, wi  LLIAH   $90. MO.. 

MAHONEY. PETER  J.  $80. MO. 

FOSTER . ANDR  EW     $35 . MO. 
STANDISH.CHARUES  $90. MO. 

HARRIS. ALFRED  L.  $90. MO. 
CASS  I DY, FRANC  I S   $75. MO. 

MURPHY, JOHN  J.    $85. MO. 
-CARTER. ARTHUR  V.  $80. MO. 

KEENAN, WALTER     $40. HO. 
BENDER. DAN  I  EL     $35vMO. 

CARLSON, EDWIN  P.  $40. MO. 


¥coo 
3ooo 
/75c 
/Soo 
?&7, 

/iS'c- 


Mia. 


■£)eei. 


7 foe 

S3'oo 

^000 


Joit/hy  'p.  \-}wrdicjiJ 


■-jhici£^ii^^}^/0.'. 


This  Form  should  h. 


Paid  IS  Adore  except  u  noted. 


A^^^ 


LISTING  MACHINE  FOR  MAKING  PAY-ROLLS,  ETC.  27 

only  a  small  percentage  of  the  pay-roll  sheets,  as  this  distribution 
need  be  shown  only  on  the  last  sheet  of  the  monthly  pay-roll, 
from  which  the  expenses  chargeable  to  each  accomit  can  be  posted 
to  the  Voucher  Register,  as  is  done  in  the  case  of  other  vouchers. 

It  will  be  found  convenient  to  have  pay-roll  sheets  printed  in 
loose  leaf  form  so  that  they  can  be  carried  in  suitable  binder  in  the 
order  and  number  desired,  in  order  to  properly  protect  them,  and  so 
that  when  no  longer  needed  for  frequent  reference  these  pay-roll 
sheets  can  be  removed  from  the  binder  and  can  be  properly  filed. 

Use  of  Listing  Machine  for  Making  Pay-Rolls,  Etc. 

At  the  Presbyterian  Hospital  it  has  been  found  desirable  to 
use  an  automatic  listing  machine  for  listing  names,  numbers, 
occupations  and  rates  of  pay  of  employes  on  pay-rolls,  and  names, 
numbers  and  occupations  on  time  clock  cards,  numbers,  names 
and  amounts  on  pay  envelopes  and  preparing  lists  showing  names 
and  occupations  of  all  employes. 

Such  a  machine  insures  accuracy,  lessens  expense  and  expe- 
dites the  work.  The  name  plates  give  a  current  card  index  of 
employes. 

This  machine  is  equipped  with  automatic  listing  attachments 
for  listing  employes'  names  on  pay  sheets,  and  can  be  adjusted 
to  print  to  almost  any  horizontal  ruling.  It  is  equipped  with  a 
duplicating  and  repeating  attachment,  which  permits  printing 
the  same  name  twice,  if  desired,  so  that  printing  can  be  done  on 
both  sides  of  a  time  clock  card.  Only  one  plate  is  required  for 
each  employe  for  the  printing  above  mentioned  on  time  cards, 
pay-roll  sheets  and  pay  envelopes. 

Cut-offs 'are  furnished  for  omitting  the  impression  of  certain 
portions  of  the  name  plate,  when  desired.  The  rate  can  be 
omitted  from  printing  when  making  out  the  employes'  time  clock 
cards  and  pay  envelopes,  etc. 

In  listing  the  pay-roll  sheet,  Exhibit  Bl,  illustrated  herewith, 
the  cut-off  is  used  for  omitting  the  printing  of  the  large  time 
clock  number  where  it  appears  on  the  name  plate.  The  name 
plates  usually  consist  of  three  parts,  the  frame,  the  proof-card, 
and  the  indestructible  printing  plate  in  one  or  two  sections.  The 
use  of  the  two-section  plate  greatly  minimizes  the  cost  of  main- 
tenance. The  lower  section  is  made  to  show  the  employe's  name 
and  rate  of  pay  and  can  be  slipped  out  and  discarded,  if  an  em- 


28  PAY-ROLLS 

ploye  IS  dropped  from  the  pay-roll,  or  can  be  slipped  into  another 
frame  with  another  number  when  an  employe  is  transferred 
from  one  department  to  another.  The  upper  section  of  the  plate 
with  the  number  and  occupation  remains  intact. 

Where  pay-rolls  are  large  or  subject  to  frequent  changes  and 
additions,  it  will  be  found  more  economical  and  satisfactory  to 
purchase  and  keep  in  the  office  also,  a  machine  for  embossing  the 
employes'  name  plates,  rather  than  to  have  this  work  done  by 
outside  parties. 

Changes  and  additions  can  thus  be  made  immediately  as 
they  occur,  and  the  name  plates  of  employes  kept  accurately  up 
to  date  at  all  times.  The  name  plates  can  be  kept  sorted  accord- 
ing to  departments  or  filed  alphabetically. 

On  the  morning  of  the  sixteenth,  and  on  the  morning  of  the 
first  of  each  month,  it  is  the  practice  of  The  Presbyterian  Hospital 
to  make  on  plain  sheets  of  paper  a  complete  list  of  all  persons  em- 
ployed during  the  previous  half  month. 

The  time  cards  are  removed  from  the  time  clock  rack,  and  the 
number  of  days  that  an  employe  is  entitled  to  be  paid  for  as 
shown  by  the  time  card,  is  posted  opposite  the  employe's  name, 
and  the  amount  of  pay  he  is  entitled  to  is  posted  opposite  his 
name. 

These  extensions  are  then  listed  on  an  adding  machine,  and 
the  desired  totals  are  obtained. 

These  preliminary  pay-roll  sheets,  if  it  is  considered  necessary, 
are  submitted  to  heads  of  departments  concerned  for  approval. 
When  approved,  small  pay  envelopes  are  made  up  bearing  name 
and  time  card  number  of  employe  and  amount  of  payment. 

The  amounts  shown  on  the  pay  envelopes  are  then  totaled 
on  the  adding  machine  to  see  that  the  grand  total  of  these  agrees 
with  the  grand  total  of  the  preliminary  pay-roll. 

When  these  amounts  have  been  proved  name  plates  are  again 
run  through  the  listing  machine  to  make  a  final  copy  of  the  pay- 
roll on  the  regular  pay-roll  sheets. 

Pay-rolls  may  thus  be  easily  prepared  and  ready  for  payment 
within  two  or  three  days  after  the  close  of  the  period  paid  for. 

Pay-Rolls  and  Unclaimed  Wages 

At  the  end  of  each  month  when  the  pay-roll  is  made  up,  or 
semi-monthly,  if  pay-rolls  are  paid  semi-monthly,  the  Superin- 
tendent makes  a  voucher  in  favor  of  himself  for  the  amount  of 


AXD   O-XLAIMED   WAGES  29 

the   pay-roll   and   dra-^s   from   his   Voucher   Bank   Account   the 
amount  of  cash  required  for  the  pay-roll. 

At  the  end  of  each  month  the  total  amount  of  the  pay-rolls  is 
distributed  on  the  Voucher  Register  and  is  posted  directly  to  the 
credit  side  of  a  ledger  account  entitled  "Salaries  and  Wages "'  and  is 
not  included  in  the  total  amount  of  vouchers  registered  during  the 
month  that  is  posted  to  the  credit  side  of  Voucher  Account. 

On  pay-day  the  pay-clerk  in  the  Superintendent's  office  puts 
the  amount  of  cash  due  each  employe  (except  those  who  may 
already  have  been  paid  by  time-check,  as  explained  later)  in  a 
separate  envelope  bearing  a  number  which  corresponds  with  a 
number  assigned  to  such  employe  on  the  pay-roll.  He  then  visits 
each  of  the  different  departments  of  the  hospital  and  in  the  pres- 
ence of  the  head  of  that  department,  or  his  or  her  representative, 
who  can  identify  employes,  distributes  cash  to  parties  entitled 
thereto,  who  acknowledge  receipt  of  same  by  signing  their  names 
in  the  signature  column  of  the  pay-roll. 

In  case  some  employes  are  not  on  hand  ready  to  receive  their 
pay  the  Superintendent  may  hold  such  unclaimed  wages  In  his 
safe  for  a  period  not  to  exceed  two  weeks,  to  see  if  they  are  called 
for,  and  if  not  by  that  time  claimed,  they  may  then  be  redeposited 
in  the  Superintendent's  General  Cash  Bank  Account.  There- 
after, as  any  such  unclaimed  wages  are  called  for,  it  has  been  found 
preferable  to  pay  these  by  checks  drawn  on  the  Superintendent's, 
General  Cash  Account. 

In  case  an  employe  Is  not  present  on  pay-day  to  collect  bis 
cash  and  desires  to  have  his  pay  forwarded  by  mail,  the  Super- 
intendent redeposits  in  the  bank  the  cash,  if  any,  he  may  be  hold- 
ing In  his  safe  for  account  of  such  employe  and  sends  him  a  check 
drawn  against  the  Superintendent's  General  Cash  Bank  Account 
for  the  amount  due.  Where  pay-checks  are  drawn  the  check 
number  and  date  should  be  noted  opposite  the  employe's  name  in 
the  signature  column  on  the  pay-roll. 

As  salaries  and  wages  are  paid  by  cash  or  by  check  the  total 
amount  paid  out  on  that  account  (including  payments  made  by 
pay-roll  cash  to  reimburse  Petty  Cash  Account  for  time-checks 
paid  or  for  Advances  on  account  of  salaries  made  through  Petty 
Cash)  is  entered  from  time  to  time  In  the  column  headed  "Sala- 
ries and  Wages  Paid"  on  the  credit  side  of  the  General  Cash  Book. 
At  the  end  of  each  month  the  total  of  this  column  Is  posted  direct 
to  the  debit  side  of  the  "Salaries  and  Wages  Account"  on  the 
Superintendent's  Ledger,  as  shown  later. 


30  SUPERINTENDENT'S  TIME  CHECKS 

Time  Checks 
In  case  employes  leave  the  service  of  the  Hospital  and  it  is 
desired  to  pay  them  their  salary  or  wages  before  the  regular  month- 
ly pay-roll  is  made  up,  Time  Checks,  size  73^"x33^",  consecu- 
tively numbered,  in  the  following  form  are  issued  and  properly 
certified  and  record  of  same  is  kept  on  a  stub  as  indicated.  It 
has  been  found  convenient  to  have  these  time  checks  bound  in 
small  books  with  manila  paper  cover,  containing  100  checks  each, 
one  check  per  page. 


No 190       I    No 

I  THE  PRESBYTERIAN  HOSPITAL 

^°^'""  "-^ I  TIME  CHECK— NOT  NEGOTIABLE 

Occu  ation         I  ^^^  ^'"'^ ^^" 

ccwp    ion  ^^^^  Certifies,  That employed  as 

I  has  worked days  in  month  of 190. . 

Days \  at  $ per ,  and  is  entitled  to dollars  and 

I  c^ts.  

I  SUPERINTENDENT 


Rate, 


Amount  $. 


Time  given  has  been  noted  Received  payment  in  full, 

in  time  book  opposite  name 


Witness . 
Issued  by i  Amount  $ 


When  such  time-checks  are  receipted  by  the  parties  in  wliose 
favor  they  are  made,  they  are  then  paid  in  cash  and  are  carried 
in  the  Superintendent's  Petty  Cash  Account  until  the  next  regular 
pay-day. 

When  the  pay-roll  is  made  up  records  of  time-checks  issued 
are  noted  thereon  as  indicated  on  Exhibit  B,  and  the  Super- 
intendent's Petty  Cash  Account  is  reimbursed  from  the  pay-roll 
cash  the  amount  of  money  advanced  from  his  "Petty  Cash,"  as 
shown  by  the  receipted  time-checks  carried  in  his  Petty  Cash. 
These  receipted  time-checks  should  then  be  filed  with  the  receipted 
pay-rolls  as  evidence  that  the  employes  concerned  had  received 
their  pay. 

Advances  Paid  on  Account  of  Salaries  and  Wages 

If  pay-rolls  are  paid  twice  a  month  it  should  be  entirely  un- 
necessary to  make  any  payments  on  account  of  salaries  or  wages 


CARD  RECORD  OF  UNCLAIMED  WAGES  31 

in  advance  of  pay-day,  except  perhaps  in  some  cases  to  employes 
leaving  the  service  to  whom  time-checks  may  be  given  and  cashed 
in  advance  of  the  regular  pay-day. 

If,  however,  pay-rolls  are  paid  only  once  a  month  and  if,  in 
cases  of  emergency,  it  is  deemed  advisable  to  pay  certain  em- 
ployes, who  are  not  leaving  the  service,  part  of  their  salary  or 
wages  on  account  before  pay-day,  part  payments  in  cash  may  be 
made  from  Petty  Cash  and  entered  in  detail  on  the  credit  side 
of  the  Superintendent's  Petty  Cash  Book.  For  such  payment 
a  receipt  should  be  taken  from  the  employe  concerned  reading 
about  as  follows: 

THE HOSPITAL, 

New  Yorle 19... 

This  certifies  that 

is  entitled  to Dollars    on    account 

for  services  rendered  during 


Head  of Department  or  Chief  Clerk 

Received  the  above  named  amount 

These  receipts  for  advance  salary  or  wages  should  be  carried 
by  the  Superintendent  in  his  Petty  Cash  Drawer. 

At  the  end  of  the  month,  when  the  pay-envelopes  are  made 
up,  these  receipts  should  be  returned  to  the  employes  concerned 
in  their  pay-envelopes  together  with  the  remaining  amount  of 
cash  due  them  for  services  rendered  during  the  month,  and  receipt 
for  payment  in  full  should  be  taken  from  the  employe  concerned 
in  the  signature  column  of  the  monthly  pay-roll,  and  Petty  Cash 
should  be  reimbursed  with  pay-roll  cash  accordingly. 

Card  Record  of  Unclaimed  Wages 

In  order  to  facilitate  keeping  track  of  exactly  what  unclaimed 
salaries  and  wages  go  to  make  up  the  total  amount  of  unclaimed 
salaries  and  wages  at  any  time,  a  small  card  record  is  kept  for 
each  individual  to  whom  unclaimed  salary  or  wages  may  be  due. 
This  card  record  is  made  when  any  unclaimed  salaries  or  wages 
are  deposited  by  the  Superintendent  in  the  bank. 


32  SUPERINTENDENT'S  VOUCHER  REGISTER 

Each  card  shows  the  name  of  the  person,  the  individual  monthly 
reference  number  on  the  pay-roll,  the  amount  of  salary  or  wages 
due  and  the  month  for  which  such  amount  is  due. 

As  salaries  or  wages  formerly  unclaimed,  are  called  for,  refer- 
ence is  made  to  the  card  record  of  the  individual  concerned,  which 
facilitates  reference  to  the  original  pay-roll.  Superintendent's 
checks  are  then  issued  accordingly  and  the  card  record  for  the 
individual  concerned  is  then  destroyed  and  the  number  and  date 
of  the  pay-check  is  noted  on  the  pay-roll  in  the  signature  column 
opposite  the  name  of  the  party  paid  unless  the  latter  acknowledges 
receipt  by  signing  the  pay-roll. 

At  the  end  of  each  month,  when  the  Superintendent's  Ledger 
Account  of  Salaries  and  Wages  is  balanced,  that  part  of  the 
balance  shown  on  the  credit  side  which  represents  Unclaimed 
Wages,  as  explained  in  footnote  under  "Salaries  and  Wages 
Account"  on  page  55,  must  agree  with  the  total  amount  of  un- 
claimed salaries  or  wages,  as  shown  in  detail  on  the  card  records 
of  such  unclaimed  salaries  and  wages  referred  to  above. 

Unclaimed  Wages  Transferhed  to  Surplus  and  Deficit 
Account  through  the  Treasurer's  Books 

From  time  to  time  the  Superintendent  carefully  examines  the 
card  records  of  unclaimed  wages  and  before  closing  his  books  at 
the  end  of  each  fiscal  year  he  authorizes  Journal  Entry  No.  7 
as  shown  on  page  50,  whereby  salaries  and  wages  unclaimed  for 
more  than  one  year,  which  probably  will  never  be  claimed,  are 
credited  to  Superintendent's  Account  with  Treasurer,  if  such 
action  is  approved  by  the  proper  official. 

SUPERINTENDENT'S  VOUCHER  REGISTER 

In  order  to  avoid  making  separate  entries  to  General  Ledger 
Accounts  for  each  individual  expense  incurred,  and  so  that  en- 
tries need  be  made  for  the  totals  only  at  the  end  of  each  month, 
and  to  economize  time  and  labor  in  recapitulating  results,  a  Super- 
intendent's Voucher  Register  is  used  with  headings  properly 
arranged  in  separate  columns  to  correspond  closely  with  the 
classification  of  expenses  agreed  upon,  as  illustrated  on  Exhibit  C. 

It  will  be  found  advantageous  to  have  a  Voucher  Register  in 
loose  leaf  form,  as  it  is  economical  to  have  at  least  several  hundred 
pages  of  the  Voucher  Register  printed  at  one  time.  On  account 
of  the  size  and  weight  of  these  pages,  however,  the  book  will  be 
lighter  and  more  easily  handled  if  only  a  part  of  these  pages  are 
inserted  in  the  binder  at  one  time. 


EXHIBIT  C 


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BILLS  RENDERED  PAY  PATIENTS  33 

If  there  are  apt  to  be  only  two  or  three  bills  per  month  for 
any  one  subdivision  of  expenses,  it  is  not  necessary  to  have  a 
separate  column  for  such  a  subdivision,  but  it  may  be  grouped 
with  some  other  expenses  under  the  proper  general  heading  and 
in  a  vertical  column  headed  Distribution,  the  subdivision  to  which 
it  belongs  can  be  indicated  on  the  same  line. 

For  smaller  Institutions  than  the  Presbyterian  Hospital  having 
less  monthly  bills  to  pay  and  less  subdivisions  of  expenses,  a  cor- 
respondingly smaller  Voucher  Register  than  that  illustrated  on 
Exhibit  C  would  be  entirely  suitable. 

For  a  small  hospital,  for  example,  all  Administration  Expenses 
may  be  entered  in  one  vertical  column  headed  Administration 
Expenses,  and  in  the  column  headed  "Distribution"  the  sub- 
division or  subdivisions  of  Administration  Expenses  to  which  any 
vouchers  are  chargeable  may  be  designated.  In  such  cases  where 
the  monthly  entries  in  any  one  column  are  not  very  numerous, 
it  would  not  be  difficult  at  the  end  of  each  month  to  recapitulate 
the  total  amounts  chargeable  to  each  subdivision  of  expenses. 

After  all  the  vouchers  for  the  month  have  been  entered  upon 
the  Voucher  Register,  it  is  then  a  simple  matter  to  make  the 
necessary  footings  and  recapitulation,  so  as  to  show  the  total 
expenses  for  each  and  all  of  the  different  subdivisions  called  for 
by  the  classification  of  expenses  (Schedules  2  and  3). 

These  totals  which  represent  expenses  incurred,  but  are  not 
cash  transactions,  are  then  both  debited  and  credited  direct  to 
the  proper  General  Ledger  accounts,  as  indicated  hereafter. 

References  should  be  made  on  the  Voucher  Register  to  the 
pages  of  the  Ledger  on  which  totals  are  posted.  The  figures 
required  to  show  the  details  of  Current  Expenses  (Schedule  2) 
and  Capital  Expenditures  (Schedule  3)  are  taken  by  the  Superin- 
tendent direct  from  the  Voucher  Register. 

BILLS  RENDERED  PAY  PATIENTS 

At  the  Presbyterian  Hospital  it  has  been  found  desirable  to 
have  only  one  form  of  bill,  as  shown  below,  for  use  in  billing  any 
pay  patients  for  board,  special  nursing,  etc.,  or  for  billing  other 
parties  for  any  Hospital  Earnings  (Schedule  1). 

These  bills,  each^six  inches  by  four  inches  in  size,  are  printed 
and  consecutively  numbered  in  triplicate  in  sheets  fourteen  inches 
by  sixteen  inches,  each  sheet  being  composed  of  eight  bills  with 


S4 


BILLS  RENDERED  PAY  PATIENTS 


a  two  inch  margin  on  the  left  side  for  binding.  For  convenience 
in  handling,  the  original,  duplicate  and  tripUcate  copies  are  bound 
in  proper  order  in  books  with  card  board  covers,  each  book  con- 
taining 100  sheets  (or  800  bills)  in  triphcate.     The  originals  are 


New  York  City,. 


.19. 


To  THE  PRESBYTERIAN  HOSPITAL,  Dr. 

41  EAST  70th  STREET 

For  care  of 


442 


Ward 
Private  Room 


Day*  from 

8p«cial  Nursing Days  from- 

Niehts 

Um  of  Operating  Room 

X>Ray  Service 


-incl.    Can 


Telephone  and  Telegraph- 
Other  Chareei 


printed  on  white  paper  and  the  duplicates  and  triplicates  on  buflF 
paper,  so  that  the  originals  can  be  easily  distinguished.  The  ori- 
ginal and  duplicate  copies  are  perforated  on  the  edges  so  that  one 
bill  at  a  time  may  be  detached,  as  desired.  The  triplicate  copies 
of  the  bills  are  not  perforated  as  they  remain  in  the  book  for  record. 
On  the  back  of  each  original  bill  is  printed  the  following: 

RtJtES  CONCERNIKG  BlttS  RENDERED  PATIENTS 

Oil  entering  the  Hospital  each  Pay  Ward  Patient  and  Setni-Private  Patient  is  expected  to 
tna]ce  an  advance  payment  of  at  least  the  equivalent  of  one  week's  charges  for  care. 

It  will  be  discretionary  with  the  Superintendent  in  the  case  of  each  Private  Room  Patient 
ftS  to  whether  or  not  any  advance  payments  must  be  made  on  account. 

At  the  end  of  each  week  of  the  patient's  stay  a  bill  will  ordinarily  be  rendered  for  care, 
etc.,  furnished.  Bills  when  rendered  must  be  paid  promptly  and  if  it  is  expected  that  the 
patient  is  to  remain  longer  in  the  Hospital  the  Superintendent  will  also  retain  the  original 
advance  payment  until  it  is  determined  when  the  patient  is  to  leave  the  Hospital,  when  the 
account  must  be  settled  in  full. 

Patients  admitted  to  the  Hospital  before  two  P.M.  will  be  charged  for  a  full  day  and  if 
admitted  after  two  P.M.  will  be  charged  for  one-half  day's  care  on  the  day  of  admittance. 
If  they  leave  the  Hospital  before  two  P.M.  they  will  be  charged  for  one-half  day  and  if  they 
leave  after  two  P.M.  they  will  be  charged  for  a  full  day's  care  on  the  day  of  discharge. 

At  the  end  of  each  month  bills  ■mU  be  rendered  for  such  fractional  part  of  a  week  as  may 
be  due  and  necessary  to  include  the  last  days  of  the  patient's  sUy  during  such  month  not 
already  billed  for. 

Money  paid  in  advance  for  care,  special  nursing,  etc,  will  be  tefunded  at  the  same  rate, 
when  the  service  paid  for  is  not  rendered. 

This  bill  does  not  include  the  physician's  or  -aurgeon's  fee  for  Private  Rocim  or  Seori* 
Private  Patients,  unless  so  sn^Pged. 


BILL*  REGISTER,  showing^^Distribution  of  Hospital  Earnings 

as  per  bills  r^nHereH  Cj^7/f/€/:^^'^^d^€P^'P'fX Patients 


SHEET  NO^ 


y^a/^rJ/^ 


[This  Form  should  have  faintly-ruled   horizontal   lines.      They   have  been   omitted  here  for  the  sake  of  clearness. 


LOOSE  LEAF  BILL  REGISTER  35 

When  the  original  bills  are  made  out  by  indelible  pencil  carbon 
duplicate  and  triplicate  copies  are  made  at  the  same  time.  The 
original  bill  is  sent  to  the  patient  or  the  patient's  representative. 
The  duplicate  copy  is  attached  to  the  "Ledger  Account  Card" 
of  the  patient  or  other  party  concerned,  as  described  later,  and 
serves  to  show  the  details  of  the  total  charge  on  the  bill  that  has 
been  debited  to  the  ledger  account  concerned.  The  Bill  Books 
containing  the  triplicate  copies  of  bills,  when  used,  are  marked 
on  the  front  cover  to  show  the  period  covered  and  are  filed  for 
at  least  a  year  for  future  reference,  if  needed. 

LOOSE  LEAF  BILL  REGISTER 

It  has  been  found  desirable  to  have  a  Bill  Register,  composed 
of  loose  leaf  sheets,  eight  and  one  half  inches  by  fourteen  inches, 
as  illustrated  on  the  opposite  page.  From  the  book  containing 
triplicate  copies  of  bills  rendered  for  patients  cared  for,  etc., 
postings  are  made  from  day  to  day  to  the  Bill  Register,  so  that 
the  total  monthly  Hospital  Earnings  from  Patients  or  other  parties, 
classified  as  desired,  as  represented  by  the  bills  rendered,  may 
be  obtained  promptly  after  the  close  of  each  month,  without  much 
extra  labor  at  that  period. 

Separate  sheets  of  the  Bill  Register  are  used  to  show  the  distri- 
bution of  earnings  from  Private  Room,  Semi -Private  and  Ward 
Patients,  and  from  Others  than  Patients,  in  order  to  obtain  the 
total  earnings  from  each  class,  as  shown  by  bills  rendered.  As 
entries  are  made  daily  in  the  Bill  Register,  it  is  difficult  to  tell 
at  the  first  of  the  month  just  how  much  space  will  be  required  in 
the  Bill  Register  to  list  separately  the  bills  rendered  to  Private, 
Semi-Private,  or  Ward  Patients,  etc.,  during  the  month.  It  has 
been  found  preferable,  therefore,  to  have  the  Bill  Register  in 
loose  leaf  form  with  a  suitable  canvass  covered  ring  binder  to  hold 
the  loose  leafs  at  the  top. 

It  has  also  been  found  convenient  for  reference  to  keep  filed 
together  the  Bill  Register  sheets  referring  to  the  same  class  of 
patients,  etc.,  and  to  number  these  consecutively  beginning  with 
number  one  the  first  of  each  fiscal  year. 

Bill  Register  sheets,  showing  earnings  for  four  or  five  months  pre- 
vious, which  would  probably  only  be  needed  for  reference  again 
when  the  Superintendent's  accounts  are  audited,  may  be  removed 
from  the  binder  and  properly  filled  for  reference,  thereby  making  the 
Bill  Register  a  light  book  of  comparatively  small  size,  easily  handled* 


39 


STATEMENT  OF  ACCOUNT 

"Statement  of  Account"  Forms 


In  case  bills  rendered  are  not  paid  promptly  by  patients, 
supplementary  statements,  size  5"x5",  as  shown  below,  are  sent 
to  the  delinquent  patients,  but  these  supplementary  statements 
are  not  posted  to  the  statement  showing  distribution  of  Hospital 
Earnings,  as  that,  of  course,  would  be  duplicating  entries  and 
would  give  incorrect  results. 


STATEMENT    OF   ACCOUNT 

To  The  Presbyterian  Hospital,  dt 

41  East  70th  Street,  New  York  City 

_19 

Z?«*  on  Account 

*■• 

^ ' 

1*^ 

Card  Ledger  Account  with  Each  Pat  Patient  or  Other  Party 

In  order  to  keep  proper  records  of  amounts  due  and  amounts 
paid  a  Ledger  Account  on  a  card,  size  six  inches  by  four  inches, 
is  kept  with  each  pay  patient  or  other  party  with  whom  an  account 
which  concerns  Hospital  Earnings  (Schedule  1),  is  kept.  These 
cards  are  printed  differently  on  each  side,  as  shown  on  page  37. 

From  the  triplicate  copy  of  each  bill  rendered  any  patient  or 
other  party,  the  date,  bill  number  and  total  amount  of  such  bill 
is  posted  to  the  debit  side  of  the  card  ledger  account  of  the  patient 
or  other  party  concerned. 

From  the  Superintendent's  Hospital  Earnings  Cash  Receipt 
Book,  described  later,  in  which  is  recorded  each  amount  paid  by 


CARD  LEDGER  ACCOUNT 


37 


or  for  a  patient,  the  date,  receipt  number  and  amount  paid  in 
payment  of  bills  rendered  is  posted  to  the  credit  side  of  the  card 


MONDAY                 1                TUESDAY                 |        •    WEDNESDAY             |              THURSDAY              ]                   FRIDAY                   |               SATUSOAV 

AODBESS                        -                                                             .   (f            ADDR|^ 

DATE 

BItl  NltMBEfl                    AMOUNT  DUE 

DATE 
...-/■0/^..~ 

RECEIPT  NUMBER 

AMOUNT  PAID 

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end  of  each  month  or  when  a  patient  is  discharged,  after  all  of  the 


Month 

DATES  OF  SPECIAL  NURSING  SERVICE 

Total 

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debits  and  credits  have  been  properly  posted  to  each  card  ledger 
account,  any  balance  shown  on  the  debit  side  of  such  an  account 
represents  an  Account  Receivable  and  any  balance  shown  on  the 


38  NURSING  AND  OTHER  MISCELLANEOUS  CHARGES 

credit  side  of  the  account  represents  an  Advance  Payment,  if  the 
patient  concerned  is  still  in  the  hospital  or  an  Overpayment,  if 
the  patient  had  left  the  hospital,  when  the  account  was  balanced. 

From  the  Superintendent's  Cash  Book,  described  later,  each 
"Overpayment  by  a  Patient  Refunded"  is  posted  to  the  debit 
side  of  the  card  ledger  account  of  the  patient  concerned,  which 
closes  the  account. 

If  Overpayments  by  Patients  are  charged  off  the  books,  on 
accoxmt  of  not  being  liable  to  be  claimed  by  patients,  as  per  Super- 
intendent's Journal  Entry  No.  4  this  fact  is  noted  and  the  amount 
is  debited  on  the  card  ledger  account  of  the  patient  concerned, 
which  closes  the  account. 

Charges  for  Special  Nursing  and  Other  Miscel- 
laneous Charges 

In  order  to  keep  a  record  of  charges  against  patients  for  special 
nursing  the  following  method  has  been  found  very  satisfactory. 

Each  morning  the  Directress  of  Nurses  sends  to  the  Superin- 
tendent's office  a  statement  showing  the  following  information: 

special  nurses   employed 

24  hours  ending  7  a.m.,  June  6,  1918 

Name  of       t»  txt    j        Name  of  Day        Name  of  Night 

^  ..     .         Room        Ward  ,,  t^t 

Patient  Nurse  Nurse 


Directress  of  Nurses 

By  reference  to  the  reverse  side  of  the  Patient's  Ledger  Ac- 
count card,  illustrated  above,  it  will  be  noted  that  space  has  been 
pro\'ided  on  which  the  Superintendent's  clerk  can  easily  post  each 
day  from  the  report  received  from  the  Directress  of  Nurses,  a 
record  of  such  day  and  night  special  nursing  as  may  have  been 
furnished  to  the  patient  concerned.  Space  is  also  provided  in 
which  the  month,  date,  amount  and  character  of  any  other  charges 
against  the  patient  concerned  may  easily  be  posted  from  requisi- 
tions or  other  memoranda  which  are  sent  to  the  office.  After 
having  been  posted,  these  memoranda  are  kept  properly  filed 
for  future  reference  for  a  reasonable  period. 


SPECIAL  NURSING  CHARGES  39 

Checking  Amount  of  Special  Nursing  Charges 

The  Bill  Register  shows  each  month  the  total  hospital  earnings 
from  special  nursing.  Di\ading  this  amount  by  the  price  per  day- 
charged  patients  for  special  nursing  will  show  the  number  of  days 
of  special  nursing  for  which  patients  were  charged. 

By  di\'iding  the  total  of  the  hospital's  monthly  pay-roll  for 
special  nurses  by  the  amount  per  day,  which  the  hospital  pays 
the  special  nurses,  the  number  of  days  for  which  special  nurses 
have  been  paid  is  found.  By  comparing  these  results  it  is  easy 
to  see  each  month  whether  patients  have  been  charged  for  all  of 
the  special  nursing  paid  for  by  the  hospital.  If  not,  it  should  be 
an  easy  matter  for  the  Superintendent's  clerk  to  show  from  his 
records,  exactly  what  special  nursing  has  been  paid  for  by  the 
hospital  and  not  charged  to  patients. 

Charge  against  Patients  for  Telephone  Messages 

In  order  to  keep  a  simple  and  proper  record  of  charges  to  be 
made  against  patients  or  others,  who  cannot  conveniently  pay 
cash  at  a  time  telephone  calls  are  made,  it  has  been  found  con- 
venient to  have  the  telephone  operator  make  a  report  daily  to 
the  Superintendent's  office  on  a  form  headed  as  follows: 

Telephone  Calls 19 —  to  be  charged  for 

Phone  No.     Exchange     Overtime     Amount     Charge  to 

From  this  list  of  telephone  calls  the  Superintendent's  clerk  posts 
promptly  the  amounts  chargeable  to  each  patient  under  the 
heading  "Other  Charges"  on  the  reverse  side  of  the  card  ledger 
account  of  the  patient  concerned,  as  illustrated  on  page  37,  so 
that  when  the  next  bill  is  rendered  against  the  patient  concerned 
the  proper  telephone  charges  will  be  included. 

Bills  for  Advance  Payments 

When  it  is  desired  to  have  a  patient  make  an  advance  payment 
on  account,  as  in  the  case  of  ward  pay  patients  on  entering  the 
hospital  or  in  other  cases,  such  payments  are  ordinarily  requested 
verbally  and  when  paid  a  receipt  from  the  Superintendent's 
Hospital  Earnings  Cash  Receipt  Book,  described  hereafter,  is  given 
for  same.     If,  however,  it  should  be  desired  to  send  a  bill  by  mail 


40  BILLS  FOR  HOSPITAL  EARNINGS  ACCRLT:D 

for  an  advance  payment  on  account,  before  services  to  be  paid 
for  are  rendered,  the  form  entitled  "Statement  of  Account" 
described  on  page  36  should  be  used. 

Bills  for  advance  payments  on  account  are  not  listed  in  the 
"Bill  Register  showing  Distribution  of  Hospital  Earnings  as  per 
bills  rendered  patients"  referred  to  on  page  35,  as  the  Bill  Register 
refers  only  to  bills  which  are  rendered  for  Hospital  Earnings 
actually  accrued. 

In  some  few  cases,  where  the  patients  have  received  care  for  a 
week  or  more  and  have  promised  to  pay,  but  have  not  paid,  and 
when  it  seems  very  doubtful  that  the  patient  can  pay,  it  may  be 
found  preferable  to  render  the  bill  on  the  statement  of  account 
form  and  not  use  the  regular  bill  form  and  not  post  the  earnings 
accrued  on  the  Bill  Register,  until  some  satisfactory  assurance 
is  had  that  the  bill  has  been  or  will  be  paid.  A  bill  on  the  regular 
form  can  then  be  rendered  and  posted  to  the  Bill  Register. 

Bills  for  Hospital  Earnings  Accrued 

Bills,  of  the  form  described  on  page  34,  are  rendered  each 
month  for  all  hospital  earnings,  which  have  accrued  on  account 
of  each  pay  patient  during  such  month,  regardless  of  any  other 
bills,  which  may  have  been  rendered  for  advance  payments  only 
and  regardless  of  whether  or  not  any  advance  payments  have 
been  paid. 

!  The  object  of  this  is  so  that  the  Bill  Book  and  the  Bill  Re- 
gister heretofore  referred  to,  may  contain  a  complete  record  of 
all  Hospital  Earnings  from  Patients. 

The  rules  printed  on  the  back  of  each  bill  rendered  to  pay 
patients  shown  on  page  34  indicate  the  practice  which  the  Presby- 
terian Hospital  has  found  desirable. 

^Tien  a  bill  is  to  be  rendered  to  or  for  account  of  a  patient 
the  Superintendent's  clerk  examines  the  card  already  mentioned 
which  shows  that  patient's  ledger  account. 

This  card  shows  the  date  the  patient  was  admitted  to  the  hos- 
pital and  if  any  bills  for  care,  etc.,  furnished  have  been  rendered 
to  such  patient  the  duplicate  copies  of  such  bills  should  be  found 
attached  by  a  small  paper  fastener  to  the  ledger  account  card  of 
the  patient  concerned. 

The  clerk  can  thus  see  for  just  what  period  any  new  bills  should 
be  rendered  and  by  examining  the  record,  already  referred  to. 


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SgpcriDteDdent,  per   ^f^ ^/3 


264 


Received  front^^_i:^^_^^^iS^^ 
$^.^    Account  nf  <^^>^  /a../fc„w!    w-Ay/ 


THE   PRESB 


THE   PRESBYTERIAN    HOSPITAL         ^ 

Superintendent,  per  V^  (2.  /^- 

266  ^^    iQ/^ 

Received  from^ — /^ /^^/-f></^^;,^^.,,/ 

ji  /g  -"    Acrniint  ofl-^^^^ 


^ 


THE   PRESBYTERIAN    HOSPITAL 

Superintendent,  per     S^q^/^. 


268 


..^ 


#^      IQ/^ 


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THE   PRESBYTERIAN    HOSPITAL 

SuperintendcDt,  pei 


270 


Received  f rnrTr-^;vaSi<^^  .^V     f^vy,^y 


-^/        19/<»^ 


THE  PRESBYTERIAN    HOSPITAL       ^ 

Saperintepdent,  per  ST  fc-  /^ 


272 


Received  Un^rf^^^  ,y&^^//    /^y^y^^t;^/-^ 
$/£^A-A.ccount  nf   (:^A^ 


-^/^/       19//^ 


THE  PRESBYTERIAN    HOSPITAL       ^ 

Superiatendent,  per      7^  »^  /v^ 

274  ^/^/     iq//- 

Received  f mm'^i^v^^ ^^"  e^  nA^i,^^^/' 

?  /■^-.°  Arrnnnt  nf      -g^^  


THE  PRESBYTERIAN    HOSPITAL 

Superintendent,  per  ^~if^ K  /3 


276  

Received  frnmJ^<gvv'r-^,.^</^»^K^.4</^./,X 
$  »^<'.-*  Account  i^f^-^ — 


THE   PRESBYTERIAN   HOSPITAL 

Superintendent,  per      ^<f^ 


4^^/  19//' 


278 


Received  fmm      cy^^y,  __  J^.  "^/^/yAAA.^ 


ys'   wf 


261 


onE^^^^i.^^ 


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RprfivfH    frnrrr<^^xfc/fcf     {^q^y^f^ 

THE   PRESBYTERIAN  •'HOSPITAL'  " 

Suge/iotflideDt,  per     A.^  ^^ 


J^^     19//^  263 


Received  frohl^^ 


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265 


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THE  PRESBYTERIAN    HOSPITAL 

Superintendent,  per    Vf^l^/^ 


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282 

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THE   PRESBYTERIAN    HOSPITAL 


SUPT.'S  HOSPITAL  EARNINGS  CASH  RECEIPT  BOOK  41 

on  the  reverse  side  of  the  ledger  account  card  can  also  see  just 
what  charges  should  be  made  for  special  nursing  and  other  charges 
for  the  period  to  be  covered  by  the  bill. 

At  the  Presbyterian  Hospital  it  is  customary  to  render  bills 
weekly  and  when  the  patient  is  discharged. 

The  last  bill  rendered  to  a  patient  in  any  month  should  in- 
clude charges  for  the  last  day,  which  the  patient  spent  in  the 
hospital  during  such  month. 

If  a  patient  spent  the  entire  month  in  the  hospital  bills  would 
ordinarily  be  rendered  on  the  7th,  14th,  21st  and  last  day  of  the 
month. 

The  object  of  having  the  words,  Monday,  Tuesday,  Wed- 
nesday, Thursday,  Friday  and  Saturday  at  the  top  of  the  ledger 
account  card  is  so  that  the  Superintendent's  clerk  can  place  a 
small  paper  fastener  on  the  card  over  one  of  these  days  and  thus 
see  at  a  glance,  even  if  the  card  is  in  the  file,  on  what  day  of  the 
week  the  next  bill  should  be  sent  to  the  patient  concerned. 

SUPERINTENDENT'S  HOSPITAL  EARNINGS  CASH 
RECEIPT  BOOK 

It  has  been  found  desirable  to  have  forms  of  receipts  issued  for 
all  payments  received  on  account  of  Hospital  Earnings  (Schedule  1). 

When  a  patient  pays  a  bill  that  has  been  rendered  there  is  no 
reason  why  the  Superintendent's  clerk  should  not  receipt  and 
return  the  bill  to  the  patient,  but  at  the  same  time  a  receipt 
should  also  be  made  out  by  indelible  pencil  in  the  Superintendent's 
Cash  Receipt  Book  for  the  amount  received,  so  that  the  Receipt 
Book  will  contain  a  complete  carbon  copy  record  of  all  receipts 
account  hospital  earnings. 

The  form'  of  receipts  illustrated  on  the  preceding  page  have 
been  found  very  satisfactory. 

These  receipts^  size  43^  inches  by  Ij^  inches,  are  printed  in 
duplicate  on  pages  11  inches  by  18  inches  composed  of  two  vertical 
rows  of  twenty-four  receipts  per  page  with  a  margin  two  inches 
wide  on  the  left  side  for  binding.  There  are  125  pages  in  dupli- 
cate per  book,  which  is  bound  with  cardboard  covers.  The  ori- 
ginal receipts  are  printed  on  cheap  white  paper  and  are  perforated 
so  they  may  be  easily  detached.  The  duplicates  are  used  for 
carbon  copies.  They  remain  in  the  book  for  record  and  are  not 
perforated  and  are  printed  on  buff  colored  paper  to  distinguish 
them  from  originals. 


42  SUPERINTENDENT'S  GENERAL  CASH  BOOK 

On  the  backs  of  the  pages  of  the  duplicate  receipts,  which  re- 
main in  the  book,  columns  are  printed  with  heading  showing  the 
classifications  of  cash  receipts  desired,  as  illustrated. 

In  these  columns  the  amounts  indicated  by  each  of  the  receipts 
on  the  opposite  page  are  entered  opposite  the  respective  receipts 
under  the  proper  headings. 

At  the  Presbyterian  Hospital  it  is  customary  for  the  clerk  in 
the  Out -Patient  Department  and  the  Pharmacist  to  turn  in  their 
earnings,  which  are  their  cash  receipts,  at  the  Superintendent's 
office  at  the  end  of  each  day  and  obtain  a  receipt  therefor. 

By  totaling  these  columns  from  day  to  day  and  carrying  for- 
ward the  totals,  the  receipts  of  cash  from  patients,  the  Out-Patient 
Department,  Pharmacy,  etc.,  may  be  easily  ascertained  at  any 
time  during  the  month  and  very  promptly  after  the  close  of  the 
month  without  much  labor  at  such  period. 

From  the  duplicate  copies  of  these  receipts  showing  payments 
made  by  patients  or  other  parties,  with  whom  card  ledger  accounts 
are  kept,  postings  are  made  to  the  credit  side  of  the  card  ledger 
account  of  each  patient  or  other  party  concerned  to  show  the 
date  and  amount  of  each  payment. 

At  the  end  of  each  month  the  totals  only  of  cash  receipts  from 
patients,  the  Out-Patient  Department,  the  Pharmacy  and  others, 
properly  classified  as  shown  by  the  Superintendent's  Cash  Re- 
ceipt Book,  are  entered  in  the  Superintendent's  General  Cash 
Book,  as  shown  later. 

By  keeping  in  the  Superintendent's  Hospital  Earnings  Cash 
Receipt  Book  such  a  detailed  record  as  that  described  of  all  cash 
received  account  Hospital  Earnings  (Schedule  1),  this  Receipt 
Book  becomes  really  a  part  of  the  Superintendent's  General  Cash 
Book  and  by  entering  the  monthly  totals  only,  properly  classified 
as  suggested,  in  the  General  Cash  Book  at  the  end  of  each  month 
considerable  time,  labor  and  space  will  be  conserved  and  there 
will  nevertheless  be  a  complete  and  satisfactory  record  of  each 
cash  transaction. 

SUPERINTENDENT'S  GENERAL  CASH  BOOK 


Sample  pages  of  the  Superintendent's  General  Cash  Book 

used  at  the  Presbyterian  Hospital  are  shown  following  page  44. 

The  total  amount  of  Cash  on  hand  at  first  of  month  plus  the 


SUPERINTENDENT'S  GENERAL  CASH  BOOK  43 

cash  received  during  month,  as  shown  in  the  debit  column  of  the 
Cash  Book  (including  receipts  shown  by  the  Superintendent's 
Hospital  Earnings  Cash  Receipt  Book,  if  not  already  posted  in 
the  General  Cash  Book) ,  less  the  total  amount  of  cash  paid  out 
during  month,  as  shown  in  the  credit  columns  of  the  Cash  Book, 
will  indicate  at  any  time  the  amount  of  cash  that  should  be  in 
the  hands  of  the  Superintendent. 

At  the  end  of  each  month  a  recapitulation  of  the  total  amount 
of  cash  received  by  the  Superintendent  during  the  month  should 
be  made  in  about  the  following  form : 

Cash  on  hand  at  first  of  month,  not  including  Petty  Cash     

Cash  Received  during  Month  Account  Hospital  Earnings: 

From  Patients,  as  per  Cash  Receipt  Book 

From  Out-Patient  Department,  as  per  Cash  Receipt 

Book 

From  Pharmacy,  as  per  Cash  Receipt  Book 

From  other  Miscellaneous  Hospital  Earnings,  as  per 

Cash  Receipt  Book  (enumerate) 

Total  cash  received  during  month  Account  Hospital 

Earnings 

Cost  price  of  General  Material  sold  during  month 

Cash  received  from  Petty  Cash  Account  daring  month. . 
Cash  received  from  Treasurer  during  month 

♦Total 


At  the  end  of  each  month  a  recapitulation  of  the  total  amount 
of  cash  paid  out  by  the  Superintendent  during  the  month  should 
be  made  in  about  the  following  form : 

Vouchers  paid  during  month 

Salaries  and  Wages  paid  during  month 

Cash  refunded  to  Patients  by  Superintendent  during  month  account 
"Overpayments  by  Patients"  for  care  or  services  never  rendered 
and  not  to  be  rendered .... 

Cash  remitted  to  Treasurer  during  month  account  cash  received  by 
Superintendent  in  payment  of  Bills  rendered  Patients  and  includ- 
ing Out-Patient  Department,  Pharmacy  and  other  Miscellaneous 
Receipts,  account  Hospital  Earnings  or  account  General  Material 
Sold 

Cash  advanced  to  Petty  Cash  Account  during  month 

Cash  on  hand  at  end  of  month,  not  including  Petty  Cash 

♦Total 

*  These  totals  should  agree 


44  SUPERINTENDENT'S  GENERAL  CASH  BOOK 

If  these  above  mentioned  recapitulations  are  made  at  the  end 
of  each  month  on  the  Superintendent's  Cash  Book,  this  Cash  Book 
can  be  considered  as  the  Superintendent's  Cash  Ledger  Account, 
and  there  will  be  no  necessity  of  his  carrying  a  Cash  Account 
on  his  Ledger  in  addition. 

From  the  Superintendent's  Cash  Book  each  "Overpayment 
by  a  Patient  Refunded"  is  posted  to  the  debit  side  of  the  Card 
Ledger  Account  of  the  patient  concerned. 

At  the  end  of  each  month  the  following  credits  and  debits 
are  posted  from  the  Cash  Book  direct  to  the  accounts  mentioned 
in  the  Superintendent's  Ledger. 

The  total  "Cash  Received  during  month  account  Hospital 
Earnings"  as  shown  in  the  debit  column,  is  credited  to  "Bill 
Account." 

Cash  received  account  cost  price  of  General  Material  sold 
and  account  handling  charges  on  General  Material  sold,  if  bills 
were  rendered,  is  credited  to  "Bill  Account." 

Cash  received  account  cost  price  of  General  Material  sold  for 
cash,  if  no  bills  were  rendered,  is  credited  direct  to  General  Mate- 
rial Account. 

Cash  received  account  handling  charges  on  General  Material 
sold  for  cash,  if  no  bills  were  rendered,  is  treated  as  a  part  of 
Hospital  Earnings. 

"Cash  received  from  Treasurer  during  month"  is  credited  to 
"Superintendent's  Account  with  Treasurer." 

The  total  "Vouchers  Paid  during  month"  as  shown  on  the 
credit  side,  is  debited  to  "Voucher  Account." 

"Salaries  and  Wages  Paid  during  month"  is  debited  to  "Sala- 
ries and  Wages  Account." 

"Cash  Refunded  to  Patients  by  Superintendent  during 
month  account  Overpayments  by  Patients"  is  debited  to  "Bill 
Account." 

"Cash  remitted  to  Treasurer  during  month"  account  cash 
received  by  Superintendent  account  Hospital  Earnings  and  Gene- 
ral Material  sold  is  debited  to  "Superintendent's  Account  with 
Treasurer." 

Proper  references  are  made  on  the  Cash  Book  in  each  case  to 
the  pages  of  the  Ledger  to  which  postings  are  made  and  references 
are  made  in  the  Ledger  to  the  pages  of  the  Cash  Book  from  which 
postings  are  made. 


66 


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ACCOUNTS   AND   REMARKS 


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CASH  REMITTANCES  BY  TREASURER  TO 
SUPERINTENDENT 

At  the  Presbyterian  Hospital,  where  pay-rolls  are  paid  about 
the  eighteenth  of  each  month  for  the  first  fifteen  days  of  the 
month  and  where  pay-rolls  for  the  last  half  of  each  month 
are  paid  about  the  third  of  the  following  month,  it  is  customary 
for  the  Superintendent,  about  the  tenth  or  twelfth  of  each 
month,  to  make  a  careful  estimate  of  the  probable  amount  of 
the  pay-roll  for  the  first  half  of  that  month.  This  he  does  by 
knowing  exactly  what  the  pay-roll  was  for  the  first  half  of  the 
previous  month  and  by  considering  the  probable  amount  of  in- 
crease or  decrease  due  to  increase  or  decrease  in  force  made  since 
the  previous  month. 

By  the  tenth  or  twelfth  of  each  month  the  Super- 
intendent also  knows,  from  his  Voucher  Register,  the  total 
amount  of  properly  approved  audited  vouchers  covering  bills 
for  the  previous  month,  which,  at  the  Presbyterian  Hospital,  it 
is  the  practice  to  pay  about  the  fifteenth  of  the  month,  except 
as  noted  below. 

The  Superintendent  then  draws  a  draft  on  the  Treasurer 
for  the  amount  of  money  he  expects  to  require  to  pay  the  pay- 
roll for  the  first  half  of  the  month  plus  the  total  amount  of 
his  audited  vouchers  for  the  previous  month,  as  shown  by  his 
Voucher  Register  not  including  pay-roll  charges  shown  by  the 
Voucher  Register. 

If  any  two  members  of  the  Executive  Committee,  approve 
and  sign  this  draft  it  is  forwarded  to  the  Treasurer  and  authorizes 
him  to  remit  to  the  Superintendent  a  check  for  the  amount 
requested. 

Likewise  about  the  twenty-fifth  or  twenty-seventh  of  each 
month  the  Superintendent  draws  a  draft  on  the  Treasurer 
for  the  estimated  amount  of  the  pay-roll  for  the  last  half  of 
the  month.  A  check  for  this  amount,  in  due  course,  is  for- 
warded to  him  by  the  Treasurer  upon  receipt  of  a  draft  signed 
by  two  members  of  the  Executive  Committee  authorizing  such 
remittance. 

The  form  of  draft,  size  7^  inches  by  3%  inches,  and  the  stub 
on  which  record  of  same  is  kept  are  as  illustrated  below.  The 
drafts  and  stubs  are  consecutively  numbered.     It  has  been  found 

45 


46  CASH  REMITTANCES  BY  SUPT.  TO  TREAS. 

convenient  to  have  them  printed  in  books  containing  about  200 
drafts  per  book,  with  two  drafts  per  page. 

Inasmuch,  however,  as  there  is  always  a  large  percentage  of 
monthly  bills  on  which  a  discount  of  one  or  two  per  cent,  can  be 
obtained  if  payments  are  made  within  ten  days  from  date  of  in- 
voice, it  has  been  found  advantageous  to  avail  of  such  discounts, 
when  there  is  no  question  about  the  correctness  of  the  bill,  by 
paying  such  bills  promptly.  For  that  purpose  the  Treasurer  has 
given  to  the  Superintendent  for  deposit  in  the  latter's  "Voucher 
Bank  Account"  a  working  fund  of  about  $7,000.00  on  which  the 
Superintendent  can  temporarily  draw,  until  the  working  fund  is 
reimbursed  by  the  usual  remittances  from  the  Treasurer  to  the 
Superintendent. 

CASH  REMITTANCES  BY  SUPERINTENDENT 
TO  TREASURER 

About  the  fifteenth  and  thirtieth  of  each  month,  or  oftener  if 
desired,  the  Superintendent  remits  to  the  Treasurer  a  check  on 
account  of  cash  received  by  Superintendent  in  payment  of  bills 
against  patients  and  including  Out -Patient  Department,  Phar- 
macy and  other  Miscellaneous  Receipts  account  Hospital  Earn- 
ings or  for  General  Material  sold. 

When  the  Superintendent  makes  the  remittances  referred  to 
he  should  always  retain  in  his  general  cash  account  a  small  bal- 
ance sufficient  to  meet  any  further  immediate  requirements  of 
his  Petty  Cash  Account,  described  later,  or  to  meet  any  immediate 
payments  he  may  be  called  on  to  make  in  refunding  any  Over- 
payments by  Patients. 

THE  SUPERINTENDENT'S  BANK  ACCOUNTS 

The  Superintendent  will  ordinarily  find  it  most  convenient  to 
have  two  separate  accounts  with  the  bank  in  which  he  deposits 
funds,  as  this  will  facilitate  balancing  his  bank  accounts  or  locating 
any  error. 

The  first  account  is  called  the  "Superintendent's  Voucher 
Bank  Account"  or  simply  "Superintendent's  Voucher  Account." 
In  this  account  the  Superintendent  deposits  the  checks  he  re- 
ceives from  the  Treasurer  and  also  any  cash  receipts  that  are 
treated  as  credits  to  current  expenses.     From  this  account  are 


SUPERINTENDENT'S  PETTY  CASH  BOOK  47 

paid  the  voucher  checks  drawn  by  the  Superintendent  in  favor  of 
various  parties  for  current  expenses  or  capital  expenditures  of 
the  Hospital  paid  through  his  office. 

The  second  account  is  called  the  "Superintendent's  General 
Cash  Bank  Account"  or  simply  "Superintendent's  Account." 
In  this  account  is  deposited  the  cash  received  through  the  Super- 
intendent's office  account  Hospital  Earnings,  General  Material 
sold  and  also  unclaimed  wages  deposited  temporarily  in  this  ac- 
count and  any  remittances  of  surplus  cash  or  checks  from  the 
Superintendent's  Petty  Cash  Account  described  later. 

From  the  Superintendent's  General  Cash  Account  are  paid 
by  Superintendent's  check,  some  pay-checks  and  also  checks 
covering  refunds  on  account  of  overpayments  made  by  or  on 
account  of  patients  (as  the  endorsement  on  the  check  serves  as  a 
receipt  for  the  payment) ,  and  the  various  remittances  made  by  the 
Superintendent  to  the  Treasurer  on  account  of  Hospital  Earnings, 
and  also  checks  in  favor  of  the  Superintendent  for  advances  to 
Petty  Cash  to  enable  him  to  pay  minor  Miscellaneous  Hospital 
Petty  Cash  Expenditures  and  to  cash  such  time-checks  or  other 
checks,  etc.,  as  are  absolutely  necessary. 

SUPERINTENDENT'S  PETTY  CASH  BOOK 

In  order  to  economize  space  in  the  Superintendent's  General 
Cash  Book,  and  to  have  some  suitable  record  in  which  certain 
Petty  Cash  expenditures  can  be  originally  entered  before  they 
are  finally  grouped  together  and  covered  by  suitable  vouchers  in 
the  usual  manner,  it  will  be  found  advantageous  and  economical 
for  the  Superintendent  to  have  a  Petty  Cash  Book  in  addition  to 
his  General  Cash  Book. 

This  Petty  Cash  Book  should  have  on  each  page  columns  headed 
as  follows: 


PETTY  CASH  FOR  MONTH 191. 

Dr.  Cr. 


If  many  advances  on  account  of  salaries  and  wages  are  paid 
before  pay-day,  it  may  be  found  advisable  to  insert  another  credit 


48  SUPERINTENDENT'S  PETTY  CASH  BOOK 

column' in  the  Petty  Cash  Book  with  the  heading  "Advance  Pay- 
ments on  Account  of  Salaries  and  Wages.'* 

By  having  debit  and  credit  entries  on  the  same  page,  but  in 
separate  columns  as  indicated,  there  is  great  economy  in  space  as 
compared  with  having  separate  debit  and  credit  pages,  as  nearly 
all  of  the  entries  made  in  the  Petty  Cash  Book  are  for  minor 
disbursements. 

The  disbursements  recorded  in  the  Petty  Cash  Book  would  be 
for  cashing  of  time-checks  in  advance  of  pay-day,  for  advances  on 
account  of  salaries  and  wages,  for  miscellaneous  petty  cash  ex- 
penditures, which,  in  due  course  are  to  be  covered  by  a  suitable 
voucher  in  favor  of  the  Superintendent  to  reimburse  Petty  Cash, 
and  cash  returned  to  the  Superintendent's  General  Cash  Account, 
when  more  cash  than  necessary  accumulated  in  the  Petty  Cash 
Account. 

The  only  receipts  recorded  in  the  Petty  Cash  Book  would  be 
advances  from  the  Superintendent's  General  Cash  Account  and 
cash  received  to  reimburse  Petty  Cash  for  the  miscellaneous  petty 
cash  expenditures  referred  to  above  and  pay-roll  cash  received 
on  pay-day  to  reimburse  Petty  Cash  Account  for  time-checks 
cashed  and  for  advances  account  salaries  and  wages  paid. 

If  at  any  time  the  Superintendent  had  in  his  cash  drawer  more 
cash  or  checks  to  the  credit  of  his  Petty  Cash  Account  than  would 
be  needed  in  the  immediate  future,  he  should  deposit  a  part  of 
this  in  the  bank  and  debit  his  General  Cash  Account  and  credit 
his  Petty  Cash  Account  accordingly. 

If  the  Petty  Cash  Book  is  balanced  at  the  end  of  each  month 
this  Petty  Cash  Book  can  be  considered  as  the  Superintendent's 
Petty  Cash  Ledger  Account,  and  there  will  be  no  necessity  of  his 
carrying  a  Petty  Cash  Account  on  his  ledger  in  addition. 

SUPERINTENDENT'S  JOURNAL 

As  will  be  seen  from  the  preceding  paragraphs  many  of  the 
entries  made  in  the  Superintendent's  General  Ledger  Accounts 
are  posted  direct  from  his  Cash  Book  and  Voucher  Register. 
In  order,  however,  to  indicate  to  what  ledger  accounts  other 
items  are  debited  and  credited  and  to  show  each  month  what 
goes  to  make  up  Hospital  Earnings  (Schedule  1),  a  Superinten- 
dent's Journal  is  kept.     Each  Journal  Entry  should  be  dated. 

At  the  present  time  at  the  Presbyterian  Hospital  about  seven 


SUPERINTENDENT'S  JOURNAL  49 

kinds  of  Journal  Entries,  as  indicated  below,  are  found  necessary 
in  the  Superintendent's  office.  Only  one  of  these,  the  first,  is 
used  every  month,  and  by  means  of  this  Journal  Entry  a  complete 
recapitulation  of  Hospital  Earnings  is  made.  The  other  Journal 
Entries  are  used  about  once  a  year,  except  number  two,  which 
may  be  used  oftener.  Where  bills  are  rendered  for  Hospital 
Earnings,  as  in  the  case  of  earnings  from  Hospital  Patients  and 
certain  other  Hospital  Earnings,  the  information  required  for 
Journal  Entry  1  is  obtained  from  the  Bill  Register.  In  case 
Hospital  Earnings  are  derived  from  cash  transactions  where  no 
bill  is  rendered  and  no  record  of  same  is  made  in  the  Bill  Register, 
the  information  in  regard  to  such  Hospital  Earnings  required  to 
complete  Journal  Entry  1  is  obtained  from  the  Superintendent's 
General  Cash  Book. 

September   30,    1917 

1.     Bill  Account,  Dr 

To  Superintendent's  Account  with  Treasurer  Cr.  

For  Hospital  Earnings  Accrued  during  month 
of  as  follows : 

From  care  of  Private  Room  Patients \ 

From  Board  of  Friends  of  Patients i  as  per 

From  Care  of  Semi-Private  Patients [  . 

From  Care  of  Ward  Patients j   Agister 

Private        Semi-        Ward 

Room        Private     Patients 
Patients     Patients 

From  Special  Nursing >, 

From    Use    of    Operating  I   ^^  P^"" 

Room h^Ul 

From  X-Ray  Service )   J^egister 

From  Out-Patient  Dept.  |  as  per 

From  Pharmacy j  Cash  Book 

*From  Ambulance  Fees 

*From  Telephone  and  Tele- 
graph   

*From  Bones  and  Soap  Fat  Sold 

*From  Handling  Charges  (if  any)  on  General  Material 

sold 

*As  per  Bill  Register  if  Bills  were  rendered  or  as  per 
Cash  Book  if  Cash  transactions  and  no  bills 
rendered. 
From  Interest  allowed  during  ...  on  Supt.'s  Cash 

Balances  in  bank,  as  per  Cash  Book 

From  Other  Miscellaneous  Hospital  Earnings  (enumer- 
ate) as  per  Cash  Book  or  Bill  Register  ...   

Total  Hospital  Earnings 


50  SUPERINTENDENT'S  JOURNAL 

September    30,    1917 

2.  Bill  Account,  Dr 

To  General  Material  Account Cr  

Cost  price  of  General  Material  sold,  as  per  Bill  Register, 
pro%ading  a  bill  was  rendered  in  each  case  and  provid- 
ing it  was  not  a  cash  transaction. 

Note. — It  would  simplify  the  bookkeeping  if  General  Material  is  sold  only 
for  cash. 

September  30,  1917 

3.  Superintendent's  Account  with  Treasurer,  Dr 

To  Bill  Account Cr  

For  UncoUectible  Accounts  Receivable  charged  off  during  month,  as  reported 
to  Treasurer.     (Give  details.) 

September  30,  1917 

4.  Bill  Account,  Dr 

To   Superintendent's   Account   with   Treasiu-er.  .  .  .Cr  

For  accumulated,  unclaimed  Overpayments  by  Patients  for  services  not  ren- 
dered and  not  to  be  rendered,  which  Overpayments  are  not  liable  to  be  claimed  by 
patients  and  are  therefore  transferred,  by  authority  of  the  proper  oflficial,  to  Sur- 
plus and  Deficit  Account  through  the  Treasiu*er's  books  as  explained  hereafter. 
(Give  details.) 

(This  journal  entry  would  ordinarily  be  used  only  at  the  close  of  each  fiscal  year.) 

September  30,  1917 

5.  General  Material  Account,  Dr 

To  Superintendent's  Account  with  Treasurer. . .  .Cr  

Account  surplus  amount  of  General  Material  found  by  inventory  to  be  on 
hand  above  that  heretofore  shown  by  General  Material  Account. 

September  30,  1917 

6.  Superintendent's  Account  with  Treasurer,  Dr 

To  General  Material  Account Cr  

Loss  or  depreciation  of  General  Material,  as  shown  by  inventory. 

September  30,  1917 

7.  Salaries  and  Wages  Account,  Dr 

To    Superintendent's    Account    with    Treasurer ....  Cr.  

For  accumulated  unclaimed  wages  which  are  not  likely  to  be  claimed  and  are, 
therefore,  transferred  to  "Surplus  and  Deficit  Account"  through  the  Treasurer's 
Books  by  authority  of  the  proper  oflBcial.     (Give  details.) 

(This  journal  entry  would  ordinarily  be  used  only  at  the  close  of  each  fiscal 
year.) 


SUPERINTENDENT'S  GENERAL  MATERIAL  LEDGER  ACCOUNT     51 

When  Journal  Entries  Number  3  or  4  are  made,  proper  nota- 
tions should  likewise  be  made  on  each  of  the  "Patients  Card 
Ledger  Accounts"  concerned,  in  order  to  complete  such  records. 

When  postings  are  made  from  Journal  Entries  to  General 
Ledger  Accounts,  proper  notations  should  be  made  on  the  Journal 
to  show  the  pages  of  the  Ledger  to  which  each  item  is  posted  and 
proper  reference  should  be  made  in  each  of  these  ledger  accounts 
to  the  page  of  the  Journal  from  which  each  posting  is  made. 

SUPERINTENDENT'S   GENERAL   MATERIAL   LEDGER 

ACCOUNT 

In  some  hospitals  certain  materials  are  purchased  to  be  sold 
later,  which  are  not  properly  chargeable  to  current  expenses. 
When  such  articles  are  purchased  in  quantity  for  resale  it  will  be 
found  advisable  to  charge  same  to  a  General  Material  Account 
and  when  sold,  credit  the  cost  only  of  these  articles,  to  the  same 
account.  Any  amount  received  to  cover  handling  charges  is 
shown  on  the  Bill  Register  or  Cash  Book  as  Miscellaneous  Hos- 
pital Earnings.  The  balance  on  the  debit  side  of  this  account 
should  at  any  time  represent  the  cost  price  of  general  material 
on  hand,  as  shown  on  page  56. 

For  instance,  at  many  hospitals  it  is  the  practice  to  have  a 
standard  style  and  quality  of  uniform  for  nurses  such  as  dresses, 
aprons,  bibs,  caps,  collars  and  cuffs.  The  materials  used  in  mak- 
ing these  uniforms  are  often  purchased  by  the  hospital  in  quantity 
and  resold  to  nurses  at  cost  price  or  at  cost  price  plus  a  small 
percentage  of  five  or  ten  per  cent,  to  cover  handling  charges,  etc. 

At  the  end  of  each  fiscal  year,  or  oftener  if  necessary,  an  in- 
ventory at  cost  price  should  be  taken  of  general  material  actu- 
ally on  hand.  If  this  inventory  shows  an  excess  or  a  shortage 
of  general  material  on  hand  as  compared  with  the  amount  shown 
by  General  Material  Account  this  discrepancy  may  be  corrected 
by  Journal  Entries  5  or  6. 

SALE  OF  SUPPLIES  CREDITED  TO  CURRENT 
EXPENSES 

'  While  the  sale  by  the  hospital  of  supplies  not  carried  in  Gen- 
eral Material  Account  and  which  have  previously  been  charged 
to  current  expenses  should  ordinarily  be  discouraged  as  an  unde- 
sirable practice,  it  may  at  times  and  under  certain  circumstances 


52  CREDITS  TO  CURRENT  EXPENSES 

be  found  expedient  to  allow  doctors  or  nurses,  etc.,  to  purchase 
from  the  Hospital  certain  articles,  such  as  uniform  material,  rub- 
ber gloves,  thermometers,  scissors,  etc.  If  this  is  permitted  the 
amounts  received  up  to  the  cost  price  of  such  articles  should  be 
shown  on  the  Cash  Book  and  under  the  proper  headings  on  the 
Voucher  Register  in  red  ink  as  a  credit  to  Current  Expenses  as 
shown  on  Exhibit  C  and  the  cash  received  to  cover  the  cost  of 
articles  sold  should  be  deposited  in  the  Superintendent's  Voucher 
Bank  Accoimt.  The  profit,  if  any,  on  account  of  such  sales  should 
be  shown  on  the  Cash  Book  as  a  Miscellaneous  Hospital  Earning 
and  the  cash  received  on  account  of  profit  should  be  deposited 
in  the  Superintendent's  General  Cash  Account. 

When  entries  are  made  on  the  debit  side  of  the  Superintendent's 
General  Cash  Book  to  show  the  amount  of  cash  received  on  account 
of  the  sales  referred  to,  such  entry  should  indicate  the  cost  of  the 
material  sold  and  the  amount  of  profit  or  handling  charges. 

HOW    SUPPLIES    DONATED    MAY   BE    CHARGED   TO 
CURRENT    EXPENSES,    IF    DESIRED 

In  case  supplies  of  such  nature  as  those  ordinarily  charged  to 
current  expenses  are  donated  to  the  hospital,  and  if  it  is  desired 
to  show  the  value  of  such  supplies  as  a  charge  against  current 
expenses  in  order  to  determine  the  total  expenses  involved  in 
caring  for  patients,  the  following  method  may  be  used. 

The  Superintendent  may  make  a  voucher  in  favor  of  the 
Treasurer  for  the  amount  of  the  estimated  value  of  the  supplies 
donated,  which  is  entered  in  the  Voucher  Register  and  Cash  Book 
in  the  usual  manner  and  charged  to  the  proper  subdivision  of 
current  expenses. 

\Mien  the  Treasurer  receives  this  voucher  he  enters  the  amount 
in  his  Cash  Book  as  a  special  donation. 

ENTRIES  TO  BE  IVIADE  BY  SUPERINTENDENT  IN 
OPENING  A  NEW  SET  OF  BOOKS 

In  case  the  Superintendent  of  a  hospital  or  other  similar  insti- 
tution is  about  to  adopt  this  system  of  accounting  and  has  not 
already  on  his  books  general  ledger  accounts  such  as  "Bill  Ac- 
count," "Salaries  and  Wages  Account,"  "General  Material  Ac- 
count," "Voucher  Account"  and  "Superintendent's  Account  with 
Treasurer,"   he  may  open  such   accounts  by    making   Journal 


ENTRIES  BY  SUPT.  IN  OPENING  NEW  SET  OF  BOOKS        53 

Entries  in  about  the  following  form  and  debiting  and  crediting 
his  General  Ledger  Accounts  accordingly: 

September  30,  1917 

Superintendent's  Cash  Account  (Cash  Book),  Dr 

To  Superintendent's  Account  with  Treasurer. .  .Cr  

For  Cash  on  Hand  September  30,  1917,  not  including  Advance  Payments  by 
Patients  or  Overpayments  by  Patients. 

September    30,    1917 

Superintendent's  Cash  Account  (Cash  Book),  Dr 

To  BUI  Account Cr  

Accoimt  Advance  Payments  by  Patients  on  hand  September  30,  1917. 
Account  Overpayments  by  Patients  on  hand  September  SO,  1917. 

September  SO,  1917 

Superintendent's  Cash  Account  (Cash  Book),  Dr 

To  Salaries  and  Wages  Account Cr  

Account  Unpaid  or  Unclaimed  Wages  due  Sep- 
tember 30,  1917. 

September   30,    1917 

Bill  Account,  Dr 

To  Superintendent's  Accoimt  with  Treasurer. . . .  Cr 

For  Accounts  Receivable  due  September  30,  1917. 

September  80,  1917 

General  Material  Account,  Dr 

To  Superintendent's  Account  with  Treasurer. .  .  Cr  

For  General  Material  on  hand  September  30,  1917. 

September  30,  1917 

Superintendent's  Account  with  Treasurer,  Dr 

To  Voucher  Account Cr  

For  Audited  Vouchers  Unpaid  September  30,  1917. 


SUPERINTENDENT'S  GENERAL  LEDGER  ACCOUNTS 

The  following  examples  will  illustrate  the  various  Ledger 
Accounts  it  has  been  found  necessary  to  keep  in  the  Superintend- 
ent's office  in  the  Presbyterian  Hospital  and  the  manner  in 
which  entries  to  same  are  posted.  When  entries  are  made  to 
these  Ledger  Accounts  the  pages  of  the  books  from  which  they 
are  posted  are  referred  to  in  each  case. 

1.    SUPERINTENDENT'S  CASH  ACCOUNT 

See  explanations  under  heading  "Superintendent's  Cash  Book,"  page  44. 


2.     BILL  ACCOUNT 


De. 

*Total  from  previous  month 

Amount  of  Hospital  Earn- 
ings, Schedule  1,  accrued 
during  month,  as  per 
Journal  Entry  1 

Cost  price  (if  bills  were  ren- 
dered) of  General  Material 
sold  during  month,  as  per 
Journal  Entry  2 

Overpayments  by  Patients 
refunded  to  them  during 
month,  as  per  Cash  Book. 

Accumulated  unclaimed 
Overpayments  by  Pa- 
tients transferred  to  Su- 
perintendent's Account 
with  Treasurer,  as  per 
Journal  Entry  4 

Total 


Total  from  previous  month. 

Cash  received  by  Superin- 
tendent diu-ing  month  in 
payment  of  bills  rendered 
Patients  and  including 
Out-Patient  Department, 
Pharmacy  and  other  Mis- 
cellaneous receipts  ac- 
count Hospital  Earnings 
and  cash  received  account 
cost  price  of  General  Ma- 
terial sold  (if  bills  for 
same  were  rendered),  as 
per  Cash  Book 

Uncollectible  Accounts  Re- 
ceivable charged  off  dur- 
ing month,  as  per  Jour- 
nal Entry  3 


Cb. 


Total. 


Difference  in  totals  should  equal  "Accounts  Receivable"  less  amount  of 
"Advance  Payments"  and  "Overpayments"  by  Patients. 

The  total  amount  of  "Accounts  Receivable"  at  the  end  of  each  month,  should 
equal  the  sum  of  the  debit  balances,  as  shown  by  the  Card  Ledger  Accounts  referred 
to  on  page  36,  if  postings  have  been  properly  made. 


54 


SUPERINTENDENT'S  LEDGER  ACCOUNTS  55 

The  total  amount  of  "Advance  Payments  by  Patients"  and  "Overpayments 
by  Patients"  at  the  end  of  each  month  should  equal  the  sum  of  the  credit  bal- 
ances, as  shown  by  the  Card  Ledger  Accounts,  if  postings  have  been  properly 
made. 

If  a  patient  remains  in  the  hospital  after  the  end  of  any  month,  any  bal- 
ance to  the  credit  of  such  patient's  account  would  represent  an  "Advance 
Payment." 

If  a  patient  has  left  the  hospital  at  the  end  of  any  month,  any  balance  to  the 
credit  of  such  patient's  account  would  represent  an  "Overpayment." 

In  order  to  have  a  proper  record  for  reference  the  Superintendent's  clerk  at 
the  end  of  each  month  should  note  in  a  book  kept  for  that  purpose  a  detailed  list 
of  and  the  amounts  of  "Accounts  Receivable,"  "Advance  Payments  by  Patients" 
and  "Overpayments  by  Patients,"  as  shown  by  the  card  ledger  account  cards, 
after  these  accounts  have  been  balanced  for  the  month. 

"Overpayments  by  Patients"  are  payments  made  by  them  for  services  or 
care,  etc.,  never  rendered.  As  the  Hospital  offers  to  refund  these  "overpayments" 
to  patients  concerned,  when  they  leave  the  Hospital,  they  are  liable  to  be  claimed 
by  such  patients  at  any  time.  "Overpayments  by  Patients"  are  carried  as  a  liabil- 
ity of  the  Hospital  by  being  shown  as  a  part  of  cash  received  in  payment  of  bills 
rendered  patients  on  the  credit  side  in  "Bill  Account"  on  the  Superintendent's 
Ledger.  From  time  to  time  under  authority  of  the  proper  officials  of  the  Hospital 
a  part  of  the  amount  standing  to  the  credit  of  "Bill  Account,"  which  represents 
overpayments,  which  have  not  been  claimed  for  a  long  time  and  will  probably 
not  be  claimed,  is  transferred  by  Journal  Entry  4,  as  indicated  on  page  50  to 
"Superintendent's  Account  with  Treasurer." 

3.     SALARIES  AND  WAGES  ACCOUNT 

Db.  Cb. 

Total  from  previous  month     fTotal  from  previous  month 

Salaries  and  Wages  paid  to  Amount  of  Pay-RoU  vouch- 

employes    during     the  ers      registered      during 

month,  as  per  Cash  Book     month    as    per    Voucher 

Accumulated         imclaimed  Register , 


wages  transferred  to  Su- 
perintendent's Account 
with  Treasurer  as  per 
Journal  Entry  No.  7 

This  balance  includes  the  entire  last  pay-roll  of  the  month,  which  is  not  usually 
paid  until  the  second  or  third  of  the  following  month,  as  well  as  unclaimed  wages 
of  previous  pay-rolls. 

It  is  therefore  desirable  for  the  Superintendent  in  making  his  trial  balance  at 
the  end  of  each  month  as  shown  on  page  57  to  subdivide  the  credit  balance  into 
two  subdivisions: 

"  Unpaid  Wages  of  latest  pay-roll  (viz.  entire  amount) 

"Unclaimed  Wages  of  previous  pay-rolls" 

The  unclaimed  wages  should  agree  with  the  total  amount  of  unclaimed  wages, 
as  shown  by  the  card  records  referred  to  on  page  31. 


56 


SUPERINTENDENTS  LEDGER  ACCOUNTS 


4.  GENERAL  MATERIAL  ACCOUNT 


Db. 

*Total  from  previous  month 

General  Material  purchased 

during    month,    as    per 

Voucher  Register 

Surplus  amount  of  Greneral 
Material  found  by  inven- 
tory to  be  on  hand,  as  per 
Journal  Entry  5 


Total  from  previous  month 

Cost  price  of  General  Mate- 
rial sold  for  cash  during 
month,  as  per  Cash  Book 

Cost  price  of  General  Mate- 
rial sold  for  which  bills 
were  rendered,  during 
month,  as  per  Journal 
Entry  2  (handling  char- 
ges, if  any,  having  been 
treated  as  part  of  Hos- 
pital Earnings) 

Loss  or  depreciation  of 
General  Material,  as 
shown  by  inventory,  as 
per  Journal  Entry  6 


Total Total 

*  Difference  in  totals  equals  "General  Material  on  Hand.' 


Cb. 


5.    VOUCHER  ACCOUNT 


Db. 

Total  from  previous  month 
Vouchers  (not  including  Pay- 
Roll  vouchers)  paid  during 
month,  as  per  Cash  Book. 


Total. 


t  Total  from  previous  month 

Amoimt    of    vouchers    (not 

including  Pay-RoU  vouch- 

[   ers),     registered     during 

month,  as    per   Voucher 

Register 

Total 


Cb. 


Difference  in  totals  equals  "Audited  Vouchers  Unpaid." 
6.     SUPERINTENDENT'S  ACCOUNT  WITH  TREASURER 


Dr. 

*Total  from  previous  month 

Grand  Total  Current  Ex- 
penses, Schedule  2,  dur- 
ing month,  as  per  Voucher 
Register 

Capital    Expenditures 
Schedule  3,  diu-ing  month 
as  per  Voucher  Register. 

Cash  remitted  to  Treasurer 
during  month  as  per  Cash 
Book,  which  was  part  of 
cash  received  by  Superin- 
tendent  in   payment   of 


Total  from  previous  month 
Amoimt  of  Hospital  Earn- 
ings, Schedule  1,  accrued 
during    month,    as    per 

Journal  Entry  1 

Cash  received  during  month 
by  Superintendent  from 
Treasurer,  as    per    Cash 

Book 

Surplus  Amount  of  General 
Material  found  to  be  on 
hand,  as  per  Journal  En- 
try 5 


Ch. 


SUPERINTENDENT'S  TRL4L  BALANCE 


57 


6.     SUPT'S  ACCOUNT  WITH  TREASURER— Corefenwed 


Db. 

bills  rendered  patients 
and  including  Out-Patient 
Department,  Phannacy 
and  other  Miscellaneous 
Receipts  account  Hospi- 
tal Earnings,  and  cash 
received  account  General 
Material  sold 

Uncollectible  Accounts  Re- 
ceivable charged  off  dur- 
ing month,  as  per  Journal 
Entry  3 

Loss  or  Depreciation  of 
General  Material  charged 
off  during  month,  as  per 
Journal  Entry  6 

Total 


Cr. 


Accimiulated  unclaimed 
Overpayments  by  Pa- 
tients to  be  transferred 
to  Surplus  and  Deficit 
Account,  as  per  Journal 
Entry  4 

Accumulated  xmclaimed 
wages  to  be  transferred 
to  Surplus  and  Deficit 
Account,  as  per  Journal 
Entry  7 


Total, 


Difference  in  totals  equals  balance  shown  by  "Superintendent's  Accoimt 
with  Treasurer"  and  must  agree  with  balance  shown  in  "Treasurer's  Accoxmt 
with  Superintendent"  on  the  Treasurer's  General  Ledger. 

SUPERINTENDENT'S  TRIAL  BALANCE 

Between  the  sixth  and  eighth  of  each  month,  after  all  entries 
for  the  previous  month  to  each  Ledger  Account  have  been  made, 
totals  footed  and  balance  of  each  account  determined,  the  Super- 
intendent makes  his  Trial  Balance  in  the  following  form  by  listing 
the  debit  and  credit  balances  of  these  accounts,  the  totals  of  which 
must  agree  if  all  entries  have  been  properly  made : 


Db. 


Cr. 


Cash  in  hands  of  Superintendent,  including  Petty  Cash. 

Accounts  Receivable  (see  page  54) 

General  Material  on  Hand 

Balance  shown  by  Superintendent's  Account  with 
Treasurer 

Advance  Paj-ments  by  Patients  for  services  to  be  ren- 
dered (see  page  5.5) 

Overpayments  by  Patients  for  services  not  rendered 
and  not  to  be  rendered  (see  page  5S) 

Unpaid  Wages  of  latest  pay-roll 

Unclaimed  Wages  of  previous  pay-rolls 

Audited  Vouchers  Unpaid 

Totals,  which  should  be  equal 


58  SUPERINTENDENT'S  LEDGER  ACCOUNTS 

*At  the  first  of  each  fiscal  year  under  the  headings  "Bill  Account,"  "General 
Material  Account,"  and  "Superintendent's  Account  with  Treasurer,"  the  balance 
shown  on  the  debit  side  of  each  account  at  the  end  of  the  previous  month  should 
be  shown  on  the  debit  side  only  as"  Balance  at  first  of  Year"  instead  of  "Totals 
from  previous  months." 

fAt  the  first  of  each  fiscal  year  under  headings  "Salaries  and  Wages  Account," 
and  "Voucher  Account,"  the  balance  shown  on  the  credit  side  of  each  account  at 
the  end  of  the  previous  month  should  be  shown  on  the  credit  side  only  as  "Balance 
at  first  of  year"  instead  of  "Totals  from  previous  month." 


MONTHLY    REPORT    OF    SUPERINTENDENT    TO 
TREASURER 

Between  the  sixth  and  eighth  of  each  month  the  Superintend- 
ent sends  to  the  Treasurer  a  report  in  the  form  shown  on  the 
following  page,  which  is  a  detailed  statement  of  the  "Superin- 
tendent's Account  with  Treasurer/' 

The  balance  as  shown  by  this  account,  if  correct,  must  agree 
with  the  balance  of  the  corresponding  ledger  account  on  the  books 
of  the  Treasurer,  entitled  "Treasurer's  Account  with  Superin- 
tendent." This  report  of  the  Superintendent  also  includes  a 
copy  of  his  Trial  Balance. 

SUPERINTENDENT'S     MONTHLY     STATEMENTS     OF 
REVENUE,    EXPENSES,    AND    STATISTICS 

In  order  to  enable  the  Superintendent  to  complete  in  his  office 
Detailed  Statement  of  Current  Revenue  (Schedule  1),  it  is  custom- 
ary for  the  Treasurer,  about  the  sixth  of  each  month,  to  for- 
ward to  the  Superintendent  the  information  in  regard  to  details 
of  Current  Revenue  (Schedule  1)  (other  than  Hospital  Earnings) 
during  previous  month,  as  shown  by  the  Treasurer's  books. 

At  the  Presbyterian  Hospital  it  is  customary  to  have  state- 
ments showing  details  of  Revenue,  Expenses  and  Statistics  called 
for  on  Schedules  1  to  6  inclusive,  for  each  month,  prepared  and 
ready  for  inspection  by  the  Executive  Committee  at  its  meeting 
on  the  second  Tuesday  of  the  succeeding  month. 

COMPARATIVE  MONTH  AND  TO  DATE  STATEMENTS 

A  book  is  also  kept  showing  in  comparative  form  the  amount 
of  each  of  the  subdivisions  of  revenue,  expenses,  and  statistics 
referred  to  in  Schedules  1,  2,  3  and  6  for  each  month,  and  for  the 
period  from  the  first  of  the  fiscal  year  to  the  end  of  each  month, 
during  the  current  and  previous  years.     (See  E  xhibit  1 9,  page  118.) 

This  record  is  most  useful  and  interesting  and  shows  clearly 
and  exactly  how  revenue,  expenses  and  statistics,  during  the 
current  year,  compare  in  detail  by  months,  and  up-to-date,  with 
those  of  previous  years  and  just  where  any  increases  or  decreases 
have  occurred.  It  enables  the  management  to  promptly  locate 
any  extravagances. 

This  book  also  facilitates  securing  promptly  after  the  close  of 
each  fiscal  year  correct  totals  for  that  year  of  the  details  called 
for  by  the  Schedules. 

59 


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TREASURER'S  ACCOUNTS 

The  following  paragraphs  describe  the  various  books  used  in 
the  Treasurer's  office  of  the  Presbyterian  Hospital  and  the  manner 
in  which  entries  are  made  to  the  accounts  referred  to. 

All  Donations  to  the  Presbyterian  Hospital  are  paid  direct  to 
the  Treasurer  and  are  acknowledged  by  him  and  put  through  his 
accounts  and  do  not  appear  in  the  Superintendent's  Accounts. 

TREASURER'S  CASH  BOOK 

A  Cash  Book  ruled  in  the  ordinary  manner  is  suitable  for  use 
in  the  Treasurer's  office,  if,  as  is  the  case  at  the  Presbyterian  Hos- 
pital, he  receives  and  makes  comparatively  few  payments  during 
the  month  under  this  system  of  accounting.  If  Unrestricted 
Donations  received  are  numerous  it  is  advisable  for  the  Treas- 
urer to  keep  a  record  of  these  in  a  separate  book  and  enter  only 
the  total  amount  of  Unrestricted  Donations  received  during  each 
month  in  his  Cash  Book,  at  the  end  of  such  month,  or  more  fre- 
quently if  desired. 

All  cash  received  is  entered  in  detail  on  the  debit  side  of  the 
Cash  Book  and  must  be  credited  to  some  General  Ledger  account 
and  may,  in  some  cases,  as  explained  later,  also  be  credited  to 
any  Income  Ledger  account  concerned.  All  cash  paid  out,  as 
shown  by  the  stubs  of  the  Treasurer's  Check  Book,  is  entered  in 
detail  on  the  credit  side  of  the  Cash  Book  and  must  be  debited 
to  some  General  Ledger  account  and  may,  in  some  cases,  also  be 
debited  to  any  Income  Ledger  account  concerned. 

All  Payments  made  by  the  Treasurer  are  by  check. 

Reference  is  made  on  the  Cash  Book  to  show  the  page  of  the 
General  or  Income  Ledger  to  which  each  account  is  posted. 

It  is  customary  at  the  Presbyterian  Hospital  for  the  purpose 
of  simplifying  accounts  to  pay  all  expenses  of  the  Treasurer's 
office,  which  come  under  the  headings  "Corporation  Expenses" 
or  "Current  Expenses  from  Special  Funds  for  Stated  Purposes'* 
(Schedule  2),  by  voucher  through  the  Superintendent's  office. 

All  appropriations  from  Special  Funds  to  meet  Current  Expenses 
on  account  of  such  Funds  are  included  in  the  remittances  by  check 
made  by  the  Treasurer  to  the  Superintendent  described  on  page  45. 

Taxes  and  other  current  expenses  than  petty  current  expenses 
and  Capital  Expenditures  on  account  of  property  held  as  invest- 

61 


62  TREASURER'S  CASH  BOOK 

ment  and  not  used  for  hospital  purposes  are  ordinarily  paid  direct 
by  check  by  the  Treasurer  and  debited  to  the  proper  income  or 
investment  account,  but  if  there  is  no  income  from  the  invest- 
ment, it  may  be  found  preferable  to  pay  current  expenses  and 
taxes  on  such  investment  by  Superintendent's  voucher  and  charge 
same  as  a  part  of  Corporation  Expenses. 

The  total  amount  of  cash  on  hand  at  first  of  month  and  all 
cash  received  during  the  month  as  shown  on  the  debit  side  of  the 
Cash  Book,  including  Donations  received,  less  the  total  of  all  cash 
paid  out  during  the  month,  as  shown  on  the  credit  side  of  Cash  Book 
should  at  any  time  equal  the  amount  of  Cash  in  hands  of  Treasurer. 

As  there  may  not  be  very  many  entries  on  the  Treasurer's 
Cash  Book  during  the  month,  which  are  to  be  debited  or  credited 
to  the  same  accounts,  it  will  probably  not  be  worth  while  at  the 
end  of  the  month  to  make  any  further  recapitulation  of  cash 
received  or  cash  paid  out,  but  postings  can  be  made  direct  from 
the  original  entries  in  the  Cash  Book,  with  the  understanding, 
however,  that  the  total  only  of  all  items  to  be  posted  to  the  same 
ledger  account  may  be  posted  in  a  lump  sum. 

AT  THE  END  OF  EACH  MONTH 

THE  TOTAL  AMOUNT  OF  CASH 

PAID    DURING    MONTH    FOR 

EACH  OF  THE  ACCOUNTS  IN- 

CASH    PAID     OUT    BY    TREAS-  DICATED    MAY   BE   DEBITED 

URER   DURING   MONTH  MAY  RESPECTIVELY     DIRECT     TO 

CONSIST     MOSTLY     OF     THE  THE   FOLLOWING      GENERAL 

FOLLOWING:  .  LEDGER  ACCOUNTS: 

Cash  paid  to  Superintendent To  Treasurer's  Account  with   Superin- 
tendent. 

Investments  Purchased,  not  including 

Interest  Purchased To    "  Bonds    Account,"     "  Mortgages 

Receivable  Account,"  "Stocks  Ac- 
count" or  Other  Investment  Account 
concerned. 

Interest  Purchased To  Interest  Purchased  Account. 

Loans  and  Notes  Receivable  made ....       To  Loans  and  Notes  Receivable  Ac- 
count. 

Loans  and  Notes  Payable  paid To  Loans  and  Notes  Payable  Account. 

Mortgages  Payable  paid To  Mortgages  Payable  Account. 

Insurance  Prepaid To  Prepaid  Insurance  Account. 

Cash  paid  account  taxes  or  other  than 
petty   current   expenses  on   account 

of  Investments To     Proper    Income    or    Investment 

Account. 

Other  Miscellaneous  payments To  proper  account. 


TREASURER'S  CASH  BOOK 


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64  TREASURER'S  JOURNAL  ENTRIES 

At  the  Presbyterian  Hospital  it  has  not  been  found  necessary 
for  the  Treasurer  to  keep  any  Cash  Account  on  his  General  Ledger, 
as  the  Cash  Book  itself  answers  that  purpose. 

TREASURER'S  JOURNAL 

As  it  is  necessary  for  the  Treasurer  to  debit  or  credit  to  his 
General  Ledger  Accounts  or  to  his  Income  Ledger  Accounts  items 
which  are  not  cash  transactions,  and  which  are  not  posted  direct 
from  his  Cash  Book,  it  is  necessary  for  him  to  make  use  of  a  Jour- 
nal, wherein  he  records  for  reference  first  the  account  to  which 
each  item  is  debited  and  then  the  account  to  which  such  item  is 
credited,  and  also  notes  further  information  desirable  regarding 
details. 

When  postings  are  made  from  Journal  Entries  to  General  Led- 
ger Accounts  or  to  Income  Ledger  Accounts,  proper  notations 
should  be  made  on  the  Journal  to  show  the  pages  of  the  ledgers  to 
which  each  item  is  posted  and  proper  reference  should  be  made 
in  each  of  these  ledger  accounts  to  the  page  of  the  journal  from 
which  each  posting  is  made.  Samples  of  such  Journal  Entries 
are  as  follows: 

September  30,  1917 

1.  Treasurer's  Account  with  Superintendent,  Dr 

To  Hospital  Earnings  Accoimt Cr  

Amount  of  Hospital  Earnings,  Schedule  1,  accrued  during  month,  including 
monthly  earnings  of  Out-Patient  Department,  Pharmacy  and  other  Miscellaneous 
Hospital  Earnings,  as  per  Report  of  Superintendent  to  Treasurer. 

September  30,  1917 

2.  Treasurer's  Account  with  Superintendent,  Dr. . . .         

To  Surplus  and  Deficit  Account Cr  

Surplus  Amount  of  General  Material  found  by  inventory  to  be  on  hand,  as 
per  Report  of  Superintendent  to  Treasurer. 

Unclaimed  Overpayments  by  Patients,  not  liable  to  be  claimed,  transferred 
by  Superintendent  to  Treasurer,  as  per  Report  of  Superintendent  to  Treasurer. 

Unclaimed  Wages,  not  liable  to  be  claimed,  transferred  by  Superintendent 
to  Treasurer,  as  per  Report  of  Superintendent  to  Treasurer. 

September  30,  1917 

3.  Surplus  and  Deficit  Account Dr 

To  Treasurer's  Account  with  Superintendent. .  .  Cr  

Grand  Total  Current  Expenses  (Schedule  2),  during  month,  as  per  Voucher 
Register,  as  reported  by  Superintendent. 


TREASURER'S  JOURNAL  ENTRIES  65 

And  Total  Capital  Expenditures  (Schedule  3),  during  month,  as  per  Voucher 
Register  (show  amount  for  each  account  separately),  as  per  report  of  Superinten- 
dent to  Treasurer. 

And  Superintendent's  Uncollectible  Accounts  Receivable  charged  off  during 
month,  as  per  Report  of  Superintendent  to  Treasm-er. 

And  Loss  or  Depreciation  of  General  Material  charged  off,  as  per  Report  of 
Superintendent  to  Treasurer. 

September  30,  1917 

4.  Grand  Total  Current  Revenue  for  month  (Schedule  1)  consisting  of: 

Hospital  Earnings  Account Dr 

And  Donations,  Unrestricted  Account ....  Dr 

And  Legacies,  Unrestricted  Account Dr 

And  Income  from  Investments  held  in  Endowed 

Bed  Fund  Account Dr 

And  Income  from  Investments  held  in  General  En- 
dowment Fund  Account Dr 

And  Income  from  Investments  held  in  Other  Fund 

Accounts  (enumerate) Dr 

(The  income  of  which  is  to  be  used  to  meet  Operat- 
ing Expenses  (Schedule  2),  and  is  not  to  be  added  to 
the  principal.) 

And  Income  from  Unrestricted  Investments  Ac- 
count  Dr 

And  Appropriations  from  Special  Funds  to  meet 

Current  Expenses  Account Dr 

(Enumerate  each  separately.) 
And  any  other  accounts,  composing  Grand  Total 

Current  Revenue  for  month Dr 

To  Surplus  and  Deficit  Account Cr  

For  amounts  transferred  from  such  accounts  to  Surplus  and  Deficit  Account. 

September  30,  1917 

5.  Sites  and  Grounds  Account Dr 

Or  Buildings  Account Dr 

Or  Furniture  and  Fixtures  Account Dr 

Or  Machinery  and  Tools  Account Dr 

Or  Apparatus  and  Instruments  Account .  .Dr 

Or  Ambulances,  Live  Stock,  etc.,  Account.Dr 

Whichever  account  is  concerned. 

To  Capital  Account  (Hospital  Properties 
and  Equipment) Cr  

For  Capital  Expenditures  for  such  accounts  during  month  (Schedule  3),  as  per 
Voucher  Register,  as  reported  by  Superintendent. 

Value  of  gifts  in  shape  of  Hospital  Properties  and  Equipment  (Schedule  4), 
received  during  month,  if  capitalized. 


66  TREASURER'S  JOURNAL  ENTRIES 

September  SO,  1917 

6.  Sites  and  Grounds  Account Dr 

Or  Buildings  Account Dr 

Or  Other  Hospital  Properties  and  Equipment  Ac- 
counts (Schedule  4) Dr 

To  Surplus  and  Deficit  Account Cr  .... 

For  profit  on  sale  of  such  property.     (Give  details.) 

September  30,  1917 

7.  Capital  Account  (Hospital  Properties  and  Equip- 

ment)   Dr . . .  

To  Sites  and  Grounds  Accoimt Cr  

Or  Buildings  Account Cr  

Or  Furniture  and  Fixtures  Account Cr  

Or  Machinery  and  Tools  Account Cr 

Or  Apparatus  and  Instruments  Account Cr  

Or  Ambulances,  Live  Stock,  etc..  Account Cr  

Whichever  account  is  concerned. 

For  actual  net  loss  or  damage  account  sale,  fire  or  demolition,  etc.,  of  Hospital 
Properties  and  Equipment  (Schedule  4)  during  month,  if  not  covered  by  Reserve 
for  Depreciation. 

If  any  Reserve  for  Depreciation  has  been  established  covering  part  of  the  book 
value  of  the  property,  which  has  been  lost  or  damaged,  it  would  be  preferable  to 
use  Journal  Entry  22  as  regards  that  part  of  the  actual  net  loss  or  damage  that 
is  covered  by  a  Reserve  for  Depreciation. 

September  30,  1917 

8.  Bonds  Account Dr 

Or  Stocks  Account Dr 

Or  Other  Investments  Accounts Dr 

To  Surplus  and  Deficit  Account Cr  

For  Profit  on  Bonds,  Stocks  or  Other  Investments  sold  during  month  as  per 
Income  Ledger.     (Give  details.)     See  pages  90  and  92. 

September  30,  1917 

9.  Mortgages  Receivable  Account Dr 

Or  Bonds  Account Dr 

Or  Stocks  Account Dr 

Or  Other  Investments  Accounts Dr 

To  General  Endowment  Fund  Account. .  Cr  

Or  Other  Fimd  Accoimts Cr  

Value  of  "Mortgages  Receivable,"  "Bonds"  (not  including  interest  accrued), 
"Stocks,"  or  "Other  Investments"  Restricted  given  to  these  Reserve  Fund  Ac- 
counts during  month.     (Give  full  details.) 


TREASURER'S  JOURNAL  ENTRIES  67 

September  30,  1917 

10.  Surplus  and  Deficit  Account Dr 

To  Mortgages  Receivable  Account Cr- 

Or  Bonds  Account Cr 

Or  Stocks  Account Cr 

Or  Other  Investments  Accounts Cr 

Or  Loans  and  Notes  Receivable  Account .  .Cr 
Whichever  account  is  concerned. 
Loss  or  Depreciation  charged  off  during  month. 

Loss  on  sale  of  Bonds,  Stocks  or  Other  Investments  during  month  as  per  Income 
Ledger.     (Give  details.)     See  pages  91  and  93. 

September  30.  1017 

11.  Partly  Endowed  Bed  Fund Dr 

To  Endowed  Bed  Fund Cr  

Amounts  transferred  to  Endowed  Bed  Fund  from  Partly  Endowed  Bed  Fund, 
account  completion  of  such  Endowments  during  month.     (Give  details.) 

September  30.  1917 

12.  Endowed  Bed  Fund  Account Dr 

Or  Partly  Endowed  Bed  Fund  Account  .Dr 

Or  General  Endowment  Fund  Account. .  Dr 

Or  Other  Fund  Reserve  Account Dr 

To  Surplus  and  Deficit  Account Cr  

Amount  charged  off  such  accounts  and  credited  to  Surplus  and  Deficit  Account 
during  month,  account  liabiUty  of  Hospital  having  ceased.     (Give  details.) 

September  30,  1917  ~ 

13.  Loans  and  Notes  Payable  Account Dr 

To  Loans  and  Notes  Payable  Account Cr  

For  Loans  and  Notes  Payable  renewed  during  month,  by  signing  of  new  notes 
and  cancellation  of  old  notes,  where  it  is  desired  to  avoid  the  necessity  of  exchanging 
checks. 

September  30,  1917 

14.  Mortgages  Receivable  Account Dr .... 

Or  Bonds  Account Dr 

Or  Stocks  Account Dr 

Or  any  Other  Investment  Account Dr 

To  Donations,  Unrestricted  Account Cr  

Or  To  Legacies,  Unrestricted  Account Cr  

For  Value  of  Mortgages  Receivable,  Bonds,  Stocks,  or  Other  Investments 
unrestricted,  not  including  accrued  interest,  given  to  Hospital  during  month, 
(Give  details.) 


68  TREASURER'S  JOURNAL  ENTRIES 

September  30,  1917 

15.  Mortgages  Receivable  Account Dr 

To  Investment  Account  Concerned. . .  Cr  

Value  of  Mortgages  Receivable  received  during  month  in  full  or  part  payment 
for  property  sold. 

September  30,  1917 

16.  Surplus  and  Deficit  Accoimt Dr 

To  Treasurer's  Accounts  Receivable Cr  

For  Uncollectible  Treasurer's  Accounts  Receivable  charged  off  during  month. 
(Give  details.) 

September  30,  1917 

17.  Sites  and  Grounds  Accoimt Dr 

Or  Buildings  Account Dr 

Or  Other  Hospital    Properties    and  Equipment 

Accounts  (Schedule  4) Dr 

To  Capital  Account   (Hospital  Properties 

and  Equipment) Cr  .... 

For  Appreciation  in  value  of  such  property.     (Give  details.) 

September  30,  1917 

18.  Treasurer's  Accounts  Receivable  Accoimt.     Dr . .         

To  Income  from  Investments  held  in  any 

account  concerned Cr  

Or  To  any  Reserve  Fund  Account  con- 
cerned  Cr  

Or  to  any  Other  Revenue  or  Income  Ac- 
count (Schedule  1),  concerned Cr  

For  amounts  accrued  and  due  during  month  and  unpaid.     (Give  details.) 
September  30,  1917 

19.  Capital  Accoimt  (Hospital  Properties  and  Equip- 

ment)   Dr 

To  Surplus  and  Deficit  Account Cr         ....     . . 

For  Book  Value  of  "Sites  and  Grounds,"  "Buildings,"  "Furniture  and 
Fixtures,"  "Machinery  and  Tools,"  "Apparatus  and  Instruments,"  "Ambu- 
lances, Live  Stock,  etc.,"  or  other  "Hospital  Properties  and  Equipment,"  Schedule 
4,  sold  during  the  month,  or  for  amount  collected  during  month  from  insurance 
companies  for  such  properties  damaged  or  destroyed  by  fire,  as  shown  by  Treas- 
urer's Cash  Book,  and  as  already  posted  from  the  Treasurer's  Cash  Book  direct 
or  by  Journal  Entry  to  the  credit  side  of  each  particular  ledger  account  of  the  sub- 
division of  "Hospital  Properties  and  Equipment"  concerned. 


TREASURER'S  JOURNAL  ENTRIES  69 

September  30,  1917 

20.  Capital  Account  (Hospital  Properties  and  Equip- 

ment)  Dr 

To  Reserve  for  Depreciation  of  Hospital 

Properties  and  Equipment Cr  .... 

For  estimated  accrued  depreciation  during  the 
year  ending  September  30, 1917,  as  follows; 

(usually  at  rate  of) 
Buildings  (from  Ij^  to    3%) 

Furniture  and  Fixtures  (    "    2      "    5%) 

Machinery  and  Tools  (     "    3      "  10%) 

Apparatus  and  Instruments    (    "    3      "  10%) 
Ambulances,  Live  Stock,  etc.  (    "    5      "  10%) 
(of  book  values) 

September  30,  1917 

21.  Reserve  for  Depreciation  of  Hospital  Properties 

and  Equipment Dr 

To  Capital  Account  (Hospital  Properties 
and  Equipment) Cr  

For  extraordinary  repairs  or  renewals  made  during  month  to  Buildings,  Furni- 
ture and  Fixtiu-es,  Machinery  and  Tools  or  any  other  Hospital  Properties  and 
Equipment,  Schedule  4,  which  may  be  chargeable  to  Reserve  for  Depreciation 
and  to  cover  which  sufficient  Reserve  for  Depreciation  on  the  property  concerned 
has  been  established. 

September  30,  1917 

22.  Reserve  for  Depreciation Dr 

To  Site  and  Grounds  Account Cr 

Or  Buildings  Account Cr 

Or  Furniture  and  Fixtiu-es  Account Cr 

Or  Machinery  and  Tools  Account Cr 

Or  Apparatus  and  Instruments  Account.  Cr 
Or  Ambulances,  Live  Stock,  etc.,  Account.Cr 
Whichever  account  is  concerned. 

For  actual  net  loss  or  damage  account  sale,  fire  or  demolition,  etc.,  of  Hospital 
Properties  and  Equipment  (Schedule  4)  during  month,  which  is  covered  by  Reserve 
for  Depreciation.     (See  note  under  Journal  Entry  7.) 

September  30,  1917 

23.     Surplus  and  Deficit  Account Dr 

To    Capital    Accoimt    (Hospital    Properties    and  

Equipment Cr. 

Amount  to  be  credited  to  "Capital  Account"  to  represent  increase  of  equity 
of  the  Hospital  in  its  Properties  and  Equipment  by  reduction  of  Mortgages  Payable 
on  Hospital  Property,  as  explained  in  note  concerning  "  Capital  Account  "on  page  80. 


ENTRIES  TO  BE  IVIADE  BY  TREASURER  IN  OPENING 
A  NEW  SET  OF  BOOKS 

In  case  the  Treasurer  of  a  hospital  or  other  similar  institution 
is  about  to  adopt  this  system  of  accounting  and  has  not  already 
on  his  books  General  Ledger  Accounts,  such  as  "Bonds  Account," 
"Mortgages  Receivable  Account,"  "Stocks  Accoimt,"  "Other 
Investment  Accounts"  or  other  asset  ledger  accounts  showing 
respectively  the  various  kinds  and  book  values  of  Bonds,  Mort- 
gages Receivable,  Stocks,  Other  Investments,  or  other  assets  on 
hand,  he  may  open  such  accounts  on  his  new  General  Ledger  by 
making  suitable  entries,  to  proper  accounts  to  which  such  assets 
are  debited  and  credited,  as  shown  for  instance  by  the  following 
sample  Journal  Entries: 

September  30, 1017 

Bonds  Account Dr 

To  Endowed  Bed  Fund Cr  

For  the  following  bonds  on  hand  September  30,  1917,  if  held  in  Endowed  Bed 
Fimd.  (Give  list  of  bonds  in  detail  and  book  value  of  each,  to  be  inserted  in 
Journal  Entry  and  in  "Bonds  Account"  on  ledger.) 

September  30, 1017 

Stocks  Account Dr 

To  any  Special  Fund  Account Cr  

For  the  following  stocks  on  hand  September  30,  1917,  if  held  in  such  Special 
Fund.  (Give  list  of  stocks  in  detail  and  book  value  of  each,  to  be  inserted  in  Joiu:nal 
Entry  and  in  "Stocks  Account"  on  ledger.) 

September  30, 1917 

Mortgages  Receivable  Account Dr 

To  Smplus  and  Deficit  Account Cr  

For  the  following  Mortgages  Receivable  on  hand  September  30,  1917,  if  un- 
restricted and  not  held  in  any  Reserve  Fund.  (Give  list  of  Mortgages  Receivable 
in  detail  and  book  value  of  each,  to  be  inserted  in  Journal  Entry  and  in  "Mortgages 
Receivable  Account"  on  ledger.) 

September  30,  1917 

Accounts  Receivable  Account Dr 

To  Surplus  and  Deficit  Account Cr  

For  Accounts  Receivable  due  September  30, 1917.    (Give  details.) 

70 


TREASURER'S  JOURNAL  ENTRIES  71 

September  30, 1917 

Surplus  and  Deficit  Account Dr 

To  General  Endowment  Fund  Account. .  Cr  

Or  To  any  other  Reserve  Fund  Account.  Cr  

For  amount  of  such  Restricted  Funds  to  offset  which  no  Investments  or  other 
Assets  are  held. 

September  30,1917 

Sites  and  Grounds  Account Dr 

Or  Buildings  Account Dr 

Or  Furniture  and'Fixtures  Account Dr 

Or  Machinery  and  Tools  Account Dr 

Or  Apparatus  and  Instruments  Account  .Dr 

Or  Ambulances,  Live  Stock,  etc.,  Account-Dr  .... 
To  Capital  Account  (Hospital  Properties 

and  Equipment) Cr  

For  the  following  Sites  and  Grounds    (Give  book  values) 

Or  Buildings " 

Or  Furniture  and  Fixtures "        "        " 

Or  Machinery  and  Tools 

Or  Apparatus  and  Instruments "        "        " 

Or  Ambulances,  Live  Stock,  etc "        "    _  " 

Owned  by  the  Institution  September  30, 1917. 

Likewise  in  opening  a  new  set  of  books  if  it  is  necessary  for  the 
Treasurer  to  open  new  General  Ledger  Accounts  to  show  Liabili- 
ties already  existing,  such  as  "Mortgages  Payable"  or  "Loans 
and  Notes  Payable,"  etc.,  Journal  Entries  showing  to  what  ac- 
counts such  items  are  debited  and  credited  might  be  made  as 
follows: 

September  30,  1917 

Surplus  and  Deficit  Account Dr 

To  Mortgages  Payable  Account Cr  

Or  To  Loans  and  Notes  Payable  Accoimt.Cr  

For  Mortgages  Payable,  (List  in  detail) 

Or  For  Loans  or  Notes  Payable,  (List  in  detail) 
existing  as  a  liability  September  30,  1917. 

In  order  to  open  the  "Treasurer's  Account  with  Superintend- 
ent" the  following  journal  Entry  would  be  made: 

September  30, 1917 

Treasurer's  Account  with  Superintendent. .  Dr 

To  Surplus  and  Deficit  Account Cr  

For  Cash  advanced  to  Superintendent  September  30,  1917. 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 

In  the  Treasurer's  office  General  Ledger  Accounts  are  kept 
with  the  Superintendent;  also  for  Hospital  Earnings  and  for  each 
of  the  other  subdivisions  shown  under  the  general  heading  of 
Other  Revenue  or  Income  on  Schedule  1,  and  for  each  of  the 
headings  shown  on  Schedule  4,  except  those  shown  in  the  Super- 
intendent's Trial  Balance  heretofore  mentioned. 

It  will  be  found  convenient  at  large  hospitals  to  have  the 
Treasurer's  General  Ledger  in  loose  leaf  form,  with  lock,  as  in 
that  style  of  ledger,  accounts  can  be  at  all  times  kept  in  the  order 
desired  and  when  new  accounts  are  opened  the  new  ledger  sheet 
can  be  inserted  in  its  proper  place.  Considerable  time  and  labor 
will  thus  be  saved  in  posting,  or  in  referring  to  the  different  ac- 
counts when  desired  and  the  ledger  will  not  be  unnecessarily 
large  or  heavy. 

If  a  loose  leaf  Treasurer's  General  Ledger  is  used,  for  the  same 
reasons  it  will  also  be  found  convenient  to  have  a  loose  leaf  Treas- 
urer's Income  Ledger,  referred  to  on  page  87,  and  to  include  this 
Income  Ledger  in  the  same  binder  in  which  the  Treasurer's  General 
Ledger  Accounts  are  bound. 

The  following  illustrations  will  show  how  entries  are  made  to 
these  General  Ledger  Accounts: 

1.    TREASURER'S  CASH  ACCOUNT 

See  explanations  under  heading  "Treasurer's  Cash  Book,"  page  64. 
2.    TREASURER'S  ACCOUNT  T\TTH  SUTERINTENDEXT 

Da.  Cr. 

Total  from  previous  month     §Total  from  previous  month     

Amount  of  Hospital  Earn-  Grand  Total  Current  Ex- 
ings,  Schedule  1,  accrued  penses.  Schedule  2,  dur- 
during  month,  as  shown  ing  month,  as  per  Vouch- 
by  Report  of  Superin-  er  Register,  as  reported 
tendent  to  Treasurer  as  by  Superintendent  and 
per  Journal  Entry  1 as  per  Journal  Entry  3 

Cash  paid  to  Superintend-  Total  Capital  Expenditures 

ent  during  month,  as  per  Schedule  3,  during  month 

Treasurer's  Cash  Book as  per  Voucher  Register, 

72 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS  73 

2.    TREASURER'S    ACCOUNT    WITH   SUPERINTENDENT— Confewwed 


Db. 

Surplus  Amount  of  General 
Material  found  to  be  on 
hand  during  month,  as 
per  Report  of  Superinten- 
dent to  Treasurer,  as  per 
Journal  Entry  2 

Unclaimed  overpayments 
by  Patients  as  per  Report 
of  Superintendent  to 
Treasurer,  credited  to 
Surplus  and  Deficit  Ac- 
count, as  per  Journal  En- 
try 2 

Unclaimed  Wages,  as  per 
Report  of  Superintendent 
to  Treasurer,  credited  to 
Surplus  and  Deficit  Ac- 
count, as  per  Journal 
Entry  2 


as  reported  by  Superin- 
tendent, as  per  Journal 
Entry  3 

Cash  received  by  Treasurer 
from  Superintendent  dur- 
ing month,  as  per  Treas- 
urer's Cash  Book 

Uncollectible  Accounts  Re- 
ceivable charged  off  dur- 
ing month,  as  per  Report 
of  Superintendent  to 
Treasurer,  as  per  Journal 
Entry  3 

Loss  or  Depreciation  of 
General  Material  charged 
off  during  month,  as  per 
Report  of  Superintendent 
to  Treasurer,  as  per 
JoiuTial  Entry  3 


Ch. 


Total , 


Total . 


Difference  in  totals  equals  balance  shown  by  "Treasurer's  Account  with 
Superintendent,"  and  must  agree  with  balance  shown  by  "Superintendent's 
Account  with  Treasurer"  on  the  Superintendent's  General  Ledger. 


3.    HOSPITAL  EARNINGS  ACCOUNT 


Db. 

Total  from  previous  month 
Amount  of  Hospital  Earn- 
ings, Schedule  1,  trans- 
ferred to  Surplus  and 
Deficit  Account,  as  per 
Journal  Entry  4 


Total. 


Total  from  previous  month 
Amount  of  Hospital  Earn- 
ings, Schedule  1,  includ- 
ing monthly  earnings  of 
Out- Patient  Department, 
Pharmacy  and  other 
Miscellaneous  Hospital 
Earnings  accrued  during 
month,  as  per  Report  of 
Superintendent  to  Treas- 
m-er,  as  per  Journal  En- 
try 1 

Total 


This  account  will  balance  monthly. 


74 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


4.    DONATIONS,  UNRESTRICTED  ACCOUNT 


Total  from  previous  month 
Amount  of  Unrestricted  Do- 
nations   received    during 
month,  as  per  Treasurer's 
Cash  Book 


Dr.  Cb. 

Total  from  previous  month      .... 
Amount     of     Unrestricted 
Donations  transferred  to 
Surplus  and  Deficit  Ac- 
count, as  per  Journal  En- 
try 4 Value  of   "  Mortgages  Re- 
ceivable" or  "Bonds"  or 
"Stocks,"  or  "Other  In- 
vestments "     unrestricted 
given  to  Hospital  during 
month,    as    per    Journal 

Entry  14 

Total Total 

This  account  wiU  balance  monthly. 
Ledger  Accounts  of  "Legacies,  Unrestricted  Account"  may  be  treated  in  the 
same  manner  as  "Donations,  Unrestricted  Account." 

5.    INCOME  FROM  INVESTMENTS  HELD  IN  GENERAL 
ENDOWMENT  FUND 


Dr. 

Total  from  previous  month 
Taxes  or  other,  than  petty 
current  expenses,  if  any, 
charged  directly  against 
income  from  this  invest- 
ment, as  per  Treasurer's 

Cash  Book 

Net  Income  during  month 
from  Investments  held  in 
this  account  transferred 
to  Surplus  and  Deficit 
Account,   as  per  Journal 

Entry  4 

Total 


Cr. 


Total  from  previous  month 
Cash  received  during  month 
account  Income  from  In- 
vestments held  in  this  ac- 
count, as  per  Treasurer's 

Cash  Book 

Amount  of  Income  from  In- 
vestments held  in  this 
Account  accrued  and  due 
during  month  and  unpaid 
and  transferred  to  "Ac- 
counts Receivable,"  as 
per  Journal  Entry  18 ... . 
Total 


This  account  will  balance  monthly. 
The  General  Ledger  Accounts  "Income  from  Investments  held  in  Endowed 
Bed  Fund  Account"  or  "Income  from  Investments  held  in  any  other  Fund  Ac- 
count" (Income  only  of  which  is  to  be  used  to  meet  Current  Expenses,  and  is  not 
to  be  added  to  the  principal)  or  "Income  from  Unrestricted  Investments  Account" 
or  Other  Miscellaneous  Revenue  Accounts  should  be  treated  in  a  similar  manner 
to  some  of  those  described  above. 

The  amount  of  monthly  Income  from  Investments  held  in 
Endowed  Bed  Fund,  General  Endowment  Fund  or  any  other 
Fund,  the  Income  only  of  which  is  to  be  used  to  meet  Current 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS  75 

Expenses,  is  also  shown  by  the  Treasurer's  Income  Ledger  Ac- 
counts of  such  funds,  as  described  on  pages  95  and  96,  and  should 

agree  with  amounts  of  Income  from  Investments  held  in  such 
Funds,  as  shown  on  the  respective  General  Ledger  Accounts. 

6.    SITES  AND  GROUNDS  ACCOUNT 

Dh.  Cb. 

*TotaI  from  previous  month     Total  from  previous  monti      

Capital  Expenditures  on  tliis  Sites  and  Grounds  sold  dur- 

account  during  month,  as  ing  month,  as  per  Trea,5- 

per  Voucher  Register,  as  urer's  Cash  Book 

reported  by  Superintend-  Depreciation    or    Loss 

ent,  as   per   Journal   En-  ciiarged  off  during  month, 

try  5 and  credited  to   this  ac- 

Value  of  Sites  and  Grounds  count,  as  per  Journal  En- 
given  to  Hospital  during                             try  7 

montih,  if  capitalized,  as 

per  Journal  Entry  5 

For  Appreciation  in  value 
of  Sites  and  Grounds,  as 
per  Journal  Entry  17 

For  Profit  on  Sale  of  Sites 
and  Grounds,  as  per  Jour- 
nal Entry  6  .  . 

Total Total. 

Difference  in  totals  equals  value  of  "Sites  and  Grounds,"  as  shown  on  Books 

and  on  Balance  Sieet. 

7.    BUILDINGS  ACCOI'NT 

Db-  Cb. 

*Total  from  previous  montL     Totsl  from  previous  month      

Capital  Expenditures  on  this  Buil.iings        sold        during 

account  during  month,  as  month,  as  per  Treasurer  s 

per  Voucher  Register,  as  re-  Casii  Book 

ported  by  Superintendent,  Cash  received  durLng  month 
as  per  Journal  Entry  5 from      Insurance      Corn- 
Value  of  Buildings  given  to  panies  in  settlement  of  fire 
Hospital  during  month.,  if  loss,    as    per    Treasurer's 

capitalized,  as  per  Journal  Cash  Book 

Entry  5 Actual  Net  Loss  or  Damage 

For  Appreciation  in  value  of  caused  by  sale,  fire  or  de- 
Buildings,  as  per  Journal  molition,  charged  off  dur- 

Entry  17 ing   month   and   credited 

For  Profit  on  Sale  of  Bmld-  to   this    account,    as   per 

ings,  as  per  Journal  Entry  Journal  Entry  7  or  2^ 

6 ^___ 

Total Total 

Difference  in  totals  equals  value  of  "Buildings."  as  shown  on  Books  and  on 
Balance  Sheet, 


76 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


Note — The  Ledger  Accounts  "Furniture  and  Fixtures  Account,"  "Machinery 
and  Tools  Account,"  "Apparatus  and  Listruments  Account,"  "Ambulances,  Live 
Stock,  etc..  Account"  or  any  other  accounts  belonging  to  Hospital  Properties  and 
Equipment  (Schedule  4),  should  be  worded  in  manner  similar  to  "Sites  and  Grounds 
Accoimt,"  and  "Buildings  Account,"  as  shown  above. 


8.    MORTGAGES  RECEIVABLE  ACCOUNT 
Dr. 

*Total  from  previous  month     .... 


Cb. 


Alortgages  Receivable  pur- 
chased during  month,  not 
including  accrued  interest 
(enumerate),  as  per  Treas- 
urer's Cash  Book 

Value  of  Mortgages  Receiv- 
able unrestricted  given  to 
Hospital  during  month 
(enumerate),  as  per  Jour- 
nal Entry  14 

Value  of  Mortgages  Receiv- 
able restricted  given  to 
Hospital  during  month 
(enumerate),  as  per  Jour- 
nal Entry  9 

Value  of  Mortgages  Receiv- 
able received  during 
month  in  full  or  part  pay- 
ment for  property  sold,  as 

per  Journal  Entry  15 

Total 


Total  from  previous  month 
Mortgages    receivable    sold 
or  paid  off  during  month 
(enumerate),  as  per  Treas- 
urer's Cash  Book 

Loss  or  Depreciation  charged 
off  during  month  and 
credited  to  this  account, 
as  per  Journal  Entry  10. . . 


Total. 


Difference  ia  totals  equals  amount  of  "Mortgages  Receivable,"  as  shown  on 
Books  and  on  Balance  Sheet. 

"Loans  and  Notes  Receivable"  made  or  paid  off  are  treated  in  a  General  Ledger 
Account  in  the  same  manner  as  Mortgages  Receivable  purchased  or  paid  off. 


9.    BONDS  ACCOUNT 


Db. 

*Total  from  previous  month 
Bonds       purchased    during 
month,  not  including  ac- 
crued   interest    (enumer- 
ate),   as   per   Treasurer's 

Cash  Book 

Value  of  Bonds  unrestricted, 
not  including  accrued  in- 
terest, given  to  Hospital 
during  month  (enumer- 
ate), as  per  Journal  Entry 
14 


Cb. 


Total  from  previous  month 

Bonds  sold  during  month 
(enumerate),  as  per  Treas- 
urer's Cash  Book 

Loss  or  Depreciation  charged 
off  during  month  credited 
to  this  account,  as  per 
Journal  Entry  10 

Loss  on  sale  of  Bonds  during 
month,  as  per  Journal 
Entry  10 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


77 


9.     BONDS  ACCOUNT— Continued 

Db.  Cb. 

Value  of  Bonds  restricted, 
not  including  accrued  in- 
terest, given  to  Hospital 
during  month  (enumer- 
ate), as  per  Journal  Entry 
9 

Profit  on  bonds  sold  during 
month,  as  per  Journal  En- 
try 8 _^__ 

Total Total 

Difference  in  totals  equals  amount  of  "Bonds,"  as  shown  on  Books  and  on 
Balance  Sheet. 

Note — The  Ledger  Account  of  "Stocks  Account"  (Schedule  4),  should  be 
worded  in  a  manner  similar  to  "Bonds  Accoimt,"  as  shown  above. 

For  Other  Miscellaneous  Investments  it  will  be  found  advisable 
to  keep  a  separate  General  Ledger  Account  in  each  case,  to  which 
capital  expenditures  on  account  of  such  investments  should  be 
debited  and  capital  receipts  credited. 

For  instance,  if  the  investment  were  in  the  form  of  an  unoccu- 
pied dwelling  house,  not  producing  any  revenue,  the  General 
Ledger  Account  for  same  might  be  treated  in  the  following  manner: 


10.    DWELLING  HOUSE.  UNFURNISHED,  AND  LOT,  900  EAST  70th  ST.. 

N.  Y. 

Dr.  Ce. 

Value    of    property,    unre-  Loss  or  Depreciation  charged 

stricted  given  to  Hospital  off  during  month,  as  per 

during     month,    as     per  Journal  Entry  10 

Journal  Entry  14 Cash  received  during  month 

Cost  of  Additions  and  Bet-  in  full  or  part  payment 

terments  during  month  as  account  sale  of  this  prop- 

per  Treasurer's  Cash  Book erty,   as   per   Treasurer's 

Taxes  and  other  than  petty  Cash  Book 

current  expenses  during  Value  of  Mortgages  Re- 
month,  which  may  be  ceivable  received  during 
charged  to  this  Account  month  in  full  or  part  pay- 
(if  there  is  no  income  ment  account  sale  of  this 
from  this  investment),  as  property,  as  per  Journal 
per  Treasurer's  Cash  Book Entry  15 

Profit  on  property  sold  dur-  Loss  on  property  sold  dur- 
ing month,  as  per  Journal  ing  month,  as  per  Journal 

Entry  8 Entry  10 

Total Total "T"!" 


78  TREASURER'S  GENERAL  LEDGER  ACCOUNTS 

If  all  of  this  property  is  sold  the  totals  as  shown  above  should 
agree.  If  a  part  only  or  none  of  this  property  is  sold,  the  balance 
on  the  debit  side  of  this  account  will  show  the  book  value  of  the 
remaining  property  at  any  time. 

11.  TREASURER'S  ACCOUNTS  RECEIVABLE  ACCOUNT 

Dr.  Cb- 

*Total  from  previous  month     Total  from  previous  month      

Amounts  accrued  and  due  Cash  received  during  month 

during  month  and  unpaid,  account    Treasurer's    Ac- 

as  per  Journal  Entry  18 counts  Receivable,  as  per 

Treasurer's  Cash  Book 

Uncollectible  Treasurer's 
Accounts  Receivable 
charged  off  during  month, 

as  per  Journal  Entry  16 

Total Total 


Difference  in  totals  equals  "Treasurer's  Accounts  Receivable,"  as  shown  on 
Books  and  on  Balance  Sheet. 

12.    INTEREST  PURCHASED  ACCOUNT 

Dh.  Cb. 

*Total  from  previous  month     Total  from  previous  month      

Accrued  Interest  Purchased  Cash  received  accoimt  In- 

during  month  when  Mort-  terest  Purchased  collected, 

gages  Receivable,  Bonds,  as  per  Treasurer's  Cash 

etc.,  are  purchased,  as  per  Book 

Treasiurer's  Cash  Book 

Total Total 

Difference  in  totals  equals  "Interest  Purchased,"  as  shown  on  Books  and  on 
Balance  Sheet. 

13.    PREPAID  INSURANCE  ACCOUNT 
Db.  Cb. 

*Total  from  previous  month     Total  from  previous  month      

Insurance    prepaid    during  Cash  received  from  Super- 

month,  as  per  Treasm-er's  intendent    during    month 

Cash  Book to     pay     for     Insurance 

charged  to  Current  Ex- 
penses, which  had  pre- 
viously been  prepaid,  as 
per  Treasurer's  Cash  Book     

Total Total 

Difference  in  totals  equals  "Prepaid  Insurance,"  as  shown  on  Books  and  on 
Balance  Sheet. 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


79 


APPORTIONING  INSURANCE  CHARGES 

When  large  biUs  for  insurance  of  various  kinds  are  rendered  they  should,  when 
approved,  be  paid  direct  by  Treasurer's  check.  Amounts  so  paid  should  be 
entered  on  the  credit  side  of  the  Treasurer's  Cash  Book  and  should  be  debited  to 
Prepaid  Insurance  Account. 

The  Treasurer  should  keep  in  his  office  and  also  furnish  to  the  Superintendent 
a  statement  showing  how  much  of  any  prepaid  insurance  is  properly  chargeable 
each  month  to  ciurrent  expenses,  so  that  each  month  the  Superintendent  can 
make  a  voucher  in  favor  of  the  Treasurer  for  such  an  amount  accordingly  and 
thus  include  the  proper  charge  in  current  expenses.  When  the  Treasurer  receives 
the  Superintendent's  voucher  check  he  debits  his  cash  account  and  credits  Pre- 
paid Insiu-ance  Account  accordingly.  If  original  bills  for  certain  kinds  of  insur- 
ance are  very  small  it  may  be  thought  best  to  pay  these  direct  by  voucher  through 
the  Superintendent's  office  and  not  apportion  the  charges  over  a  series  of  months 
during  which  the  insurance  is  in  effect. 


Db. 


14.    CAPITAL  ACCOUNT  (HOSPITAL  PROPERTIES  ANT> 
EQUIPMENT) 


Actual  Net  Loss  or  Damage 
account  sale,  fire  or  demo- 
lition, charged  off  Hos- 
pital Properties  and 
Equipment,  Schedule  4, 
during  month  and  cred- 
ited to  proper  accounts 
on  Treasurer's  General 
Ledger,    as    per    Journal 

Entry  7 

Book  Value  of  "Sites 
and  Grounds,"  "Build- 
ings," "Furniture  and 
Fixtures,"  "Machinery 
and  Tools,"  "Apparatus 
and  Instruments,"  "Am- 
bulances, Live  Stock, 
etc.,"  or  other  "Hospital 
Properties  and  Equip- 
ment," Schedule  4,  sold 
during  the  month,  or  for 
amount  collected  during 
month  from  insurance 
companies  for  such  prop- 
erties damaged  or  de- 
stroyed by  fire,  as  per 
Journal  Entry  19 


§Total  from  previous  month 

Capital  Expenditures 
Schedule  3,  during  month, 
as  per  Voucher  Register, 
as  reported  by  Superin- 
tendent, as  per  Journal 
Entry  5 

Value  of  gifts  in  shape  of 
"Hospital  Properties  and 
Equipment,"  Schedule  4, 
given  to  Hospital  during 
month,  if  capitalized,  and 
debited  to  proper  account 
on  Treasurer's  General 
Ledger,  as  per  Journal 
Entry  5 

Appreciation  in  value  of 
"Sites  and  Grounds," 
"BuUdings,"  or  other 
Hospital  Properties  and 
Equipment  as  per  Joiur- 
nal  Entry  17 

Amount  to  be  credited  to 
"  Capital  Account"  to  rep- 
resent increase  of  equity 
of  the  Hospital  in  its  Pro- 
perties and  Equipment  by 
reduction  of  Mortgages 
Payable  Account,  as  per 
Journal  Entry  23 

Total 


Cb. 


Total 

Difference  in  totals  equals  "Capital  Account"  (Hospital  Properties  and  Equip- 
ment), as  shown  on  Books  and  on  Balance  Sheet. 


80  TREASURER'S  GENERAL  LEDGER  ACCOUNTS 

Note — "Capital  Account"  ("Hospital  Properties  and  Equip- 
ment*') may  be  considered  as  practically  a  subdivision  of  "Sur- 
plus and  Deficit  Account."  The  balance  standing  to  the  credit 
of  "Capital  Account"  is  really  a  part  of  the  surplus  of  the 
hospital. 

"Capital  Account,"  which  represents  the  book  value  of  the 
hospital's  equity  in  its  working  plant,  plus  "Reserve  for  Depre- 
ciation of  Hospital  Properties  and  Equipment,"  if  any  such 
accoimt  is  established,  plus  bonds  outstanding  or  mortgages 
payable  on  Hospital  Property,  if  any,  should  equal  the  total 
book  value  of  the  assets  of  the  hospital,  which  compose  its  work- 
ing plant  or  Hospital  Properties  and  Equipment,  Schedule  4, 
such  as  "Sites  and  Grounds,"  "Buildings,"  "Furniture  and  Fix- 
tures," "Machinery  and  Tools,"  "Apparatus  and  Instruments," 
and  "Ambulance,  Live  Stock,  etc." 

By  keeping  this  "Capital  Account"  (Hospital  Properties 
and  Equipment)  out  of  "Surplus  and  Deficit  Account"  as 
here  indicated,  the  amount  of  the  deficit,  if  any,  up  to  the 
amount  of  the  Reserve  Fund  Accounts,  as  shown  by  the  "Sur- 
plus and  Deficit  Account,"  will  represent  the  exact  amount 
which  the  Reserve  Funds  of  the  Hospital  have  been  encroached 
upon. 

The  amount  of  surplus,  if  any,  as  shown  by  the  "Surplus  and 
Deficit  Account,"  will  represent  the  amount  of  surplus,  which 
the  hospital  may  have  to  its  credit,  not  including  the  equity  the 
hospital  may  have  in  its  working  plant  or  Hospital  Properties 
and  Equipment. 

If  a  mortgage  payable  on  Hospital  Property  is  fully  or  partly 
paid  ofiF  the  money  paid  should  be  entered  on  the  credit  side  of  the 
Treasurer's  Cash  Book  and  should  be  debited  to  "Mortgages  Pay- 
able Account." 

The  equity  of  the  Hospital  in  its  Properties  and  Equipment  is 
increased  by  the  amount  of  such  payment  and  reduction  in  "Mort- 
gages Payable  Account"  and  in  order  that  Capital  Account  may 
represent  this  equity  Journal  Entry  No.  23  should  be  made  and 
"Surplus  and  Deficit  Account"  should  be  debited  and  "Capital 
Account"  should  be  credited  accordingly. 

Conversely,  if  a  mortgage  payable  on  Hospital  Property  is 
created  the  money  received  should  be  entered  on  the  debit  side  of 
the  Treasurer's  Cash  Book  and  should  be  credited  to  "Mortgages 
Payable  Account."     In  order  that  Capital  Account  may  then 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS  81 

represent  the  decreased  equity  of  the  Hospital  in  its  Properties  and 
Equipment,  a  Journal  Entry,  the  reverse  of  No.  23,  should  be 
made,  whereby  "Capital  Account"  may  be  debited  and  "Surplus 
and  Deficit  Account"  may  be  credited  accordingly. 

RESERVE   FOR  DEPRECIATION  OF  HOSPITAL   PROP- 
ERTIES AND  EQUIPMENT 

In  case  it  is  desired  to  establish  a  "Reserve  for  Depreciation  of 
Hospital  Properties  and  Equipment"  (without  disturbing  the  cost 
values  and  without  reducing  book  values  below  the  values  at 
which  such  properties  may  be  insured)  to  show  the  estimated 
amount  of  depreciation  or  deferred  up-keep  on  "Buildings," 
"Furniture  and  Fixtures,"  "Machinery  and  Tools,"  or  on  other 
Hospital  Properties  and  Equipment,  Schedule  4,  the  amounts  of 
this  estimated  depreciation  ma!y  at  the  end  of  each  fiscal  year  be 
debited  to  "Capital  Account"  and  credited  to  "Reserve  for 
Depreciation  of  Hospital  Properties  and  Equipment "  by  a  journal 
entry  similar  to  No.  20. 

This  "Reserve  for  Depreciation"  would  practically  be  a  sub- 
division of  "Surplus  and  Deficit  Account"  and  the  balance  on 
the  credit  side  of  this  account  would  represent  a  part  of  the  surplus 
of  the  hospital. 

In  case  there  is  actual  net  loss  or  damage  caused  by  sale, 
fire,  or  by  demolition,  etc.,  not  covered  by  insurance,  to  any 
of  the  subdivisions  of  Hospital  Properties  and  Equipment, 
Schedule  4,  and  if  it  is  desired  to  charge  such  part  of  this  net 
loss  or  damage  as  may  be  covered  by  the  "Reserve  for  Depre- 
ciation" to  such  Depreciation  Account  this  may  be  done  by 
Journal  Entry  22. 

In  case  extraordinary  repairs  or  renewals  are  made  to  any 
of  the  subdivisions  of  Hospital  Properties  and  Equipment, 
Schedule  4,  and  if  it  is  desired  to  charge  such  part  of  such 
expenditures  as  may  be  covered  by  the  Reserve  for  Depre- 
ciation, to  such  Depreciation  Account  this  may  be  done  by 
Journal  Entry  21. 

If  a  Fund  for  Depreciation  of  Hospital  Properties  and 
Equipment,  as  outlined  above,  is  established,  one-twelfth  of  the 
estimated  amount  of  yearly  depreciation  of  Hospital  Properties 
and  Equipment  might  very  properly  be  added  to  the  actual 
monthly  Operating  Expenses,  Schedule  2,  in  order  to  ascertain 


82 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


the  full  cost  of  running  the  Hospital  and  to  figure  the  full  cost 
per  patient  per  day  (not  including  Corporation  Expenses  or  Special 
Fund  Expenses). 


15.    RESERVE  FOR  DEPRECIATION  OF  HOSPITAL  PROPERTIES  AND 

EQUIPMENT 
Dh. 


For  actual  net  loss  or  dam- 
age by  sale,  fire  or  demoli- 
tion, etc.,  charged  off 
Hospital  Properties  and 
Equipment  referred  to 
during  month,  as  per  Jour- 
nal Entry  22 

Buildings 

Furniture  and  Fixtures 

Machinery  and  Tools 

Apparatus  and  Instruments 

Ambulances,  Live  Stock,  etc. 
Total 


For  extraordinary  repairs  or 
renewals  made  during 
month  charged  to  Depwre- 
ciation  Account,  as  per 
Journal  Entry  No.  21. . . . 

Buildings 

Furniture'  and  Fixtures .... 

Machinery  and  Tools 

Apparatus  and  Instruments 

Ambulances,  Live  Stock,  etc. 
Total 


Total. 


Balance  Estimated  Depre- 
ciation from  previous  year 

Buildings  Account 

Furniture  and  Fixtures  Ac- 
count  

Machinery  and  Tools  Ac- 
count   

Apparatus  aod  Instruments 
Account 

Ambulances,  Live  Stock, 
etc..  Account 


Total. 


Estimated  depreciation  ac- 
crued during  year  ending 
,  as  per  Journal  En- 
try No.  20 

Buildings  Account 

FiuTiiture  and  Fixtures  Ac- 
count  

Machinery  and  Tools  Ac- 
count   

Apparatus  and^Instruments 
Account 

Ambulances,     Live     Stock, 

etc..  Account 

Total 

Total 


Cb. 


The  above  "Reserve  for  Depreciation"  will  cease  to  exist  unless  there  remains 
a  balance  on  the  credit  side,  which  represents  the  amount  of  this  "Reserve  for 
Depreciation  of  Hospital  Properties  and  Equipment,"  as  shown  on  the  Books  and 
on  the  Balance  Sheet. 


16.    ENDOWED  BED  FUND  ACCOUNT 
De. 

Total  from  previous  month      §  Total  from  previous  month 

Amount  charged  off  En-  Cash  received  to  fully  En- 
dowed Bed  Fund  during  dow  Beds  dm-ing  month, 
month  and  credited  to  as  per  Treasurer's  Cash 
Surplus  and   Deficit  Ac-                            Book 


Cb. 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS  83 

16.  ENDOWED  BED  FUND  ACCOUNT— Continued 

Dr.  Cb. 

count,  liability  of  Hospital  Amounts    transferred    from 

having     ceased,     as     per  "Partly     Endowed     Bed 

Journal  Entry  12 Fund"     during     month, 

accoimt     completion     of 
such  endowments  as  per 

Journal  Entry  11 

Total Total 

Difference  in  totals  equals  "Endowed  Bed  Fund,"  as  shown  on  Books  and  on 
Balance  Sheet. 

Note — When  beds  are  endowed  at  the  Presbyterian  Hospital  it  is  the  practice 
to  credit  such  endowments  to  "Endowed  Bed  Fund  Account"  and  to  keep  the 
amounts  received  invested  ia  income  bearing  seciuities,  as  long  as  any  nominor 
has  the  right  to  name  patients  to  occupy  such  beds. 

In  case,  however,  the  right  to  name  patients  to  occupy  a  bed  should  lapse, 
either  by  expiry  of  the  term  of  the  endowment  or  by  death  of  the  nominor  without 
having  appointed  in  writing  a  successor,  the  liability  of  the  hospital,  as  regards  that 
particular  endowment,  is  considered  to  have  ceased  and  the  endowment  is  there- 
after treated  as  imrestricted  and  is  credited  as  per  Journal  Entry  No.  12  to  "  Surplus 
and  Deficit  Account,"  if  such  action  is  approved  by  the  Board  of  Managers.  A 
Suitable  entry  is  also  made  on  the  Treasurer's  Endowed  Bed  Ledger  Accounts  as 
described  on  pages  99  and  100. 

17.  PARTLY  ENDOWED  BED  FUND  ACCOUNT 

De.  Cr. 

Total  from  previous  month      §  Total  from  previous  month     

Amounts     Transferred     to  Cash  received  account  Part- 

Endowed  Bed  Fund,  dur-  ly    Endowed    Bed    Fund 

ing    month,    account    en-  diu-ing    month,     as    per 

dowments  completed,  as  Treasurer's  Cash  Book 

per  Journal  Entry  11 

Amounts  charged  off  partly 
Endowed  Bed  Fimd  dur- 
ing month,  and  credited 
to  Surplus  and  Deficit 
Account  account  liability 
of  Hospital  having  ceased, 

as  per  Journal  Entry  12 

Total Total 

Difference  in  totals  equals  "Partly  Endowed  Bed  Fxmd,"  as  shown  on  Books 

and  on  Balance  Sheet. 

Note — Instalments  received  to  partly  endow  beds  are  subject  at  any  time  to 
transfer  to  "Endowed  Bed  Fund  Account"  upon  completion  of  such  endowments. 
There  is  usually  no  liability  on  the  part  of  the  Hospital  to  furnish  free  treatment 
on  such  beds  until  they  are  fully  endowed.  No  investments  are  therefore  assigned 
to  offset  amounts  standing  to  credit  of  "Partly  Endowed  Bed  Fund  Account" 
and  no  income  from  this  Account  is  therefore  shown  in  Schedule  1. 


84 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


18.    GENERAL  ENDOWMENT  FUND  ACCOUNT 

State  in  detail  purposes  and  conditions  of  this  Fund,  as  for  instance,  "Principal 
to  be  invested  and  income  only  to  be  used  for  meeting  Operating  Expenses" 
(Schedule  2). 

Cb. 


Db. 

Total  from  previous  month      

Amount  charged  off  this 
account  during  month 
and  credited  to  Surplus 
and  Deficit  Accoimt,  lia- 
bility of  Hospital  having 
ceased,  as  per  Journal  En- 
try 12  

Total ."T" 

Difference  in  totals  equals  "General  Endowment  Fund,"  as  shown  on  Books 

and  on  Balance  Sheet. 

19.    X.    Y.    Z.    \TSITING  NURSING  FUND  ACCOUNT 

State  in  detail  purposes  and  conditions  of  this  Fund,  as  for  instance.  Principal 
to  be  used  for  all  expenses  in  connection  with  work  of  Visiting  Nurses. 
Dh. 


§  Total  from  previous  month 
Cash  received  during  month 
for  this  Accoimt,  as  per 
Treasurer's  Cash  Book. . . 
Value  of  Investments  given 
to  Hospital  during  month, 
for   this   Account   as  per 

Journal  Entry  9 

Total 


Cb. 


Total  from  previous  month 
Appropriation  during 
month,  for  expenses 
chargeable  to  this  Fund,  as 
reported  by  Superintend- 
ent, as  per  Journal  Entry  4 
Total 


§  Total  from  previous  month 

Donations   received   during 

month,  for  this  Fund,  as 

per  Treasurer's  Cash  Book 


Total. 


Difference  in  totals  equals  the  amount  of  this  Fund,  as  shown  on  Books  and 
on  Balance  Sheet. 

20.    A.  B.  C.  PATHOLOGICAL  DEPARTMENT  FUND  ACCOUNT 

State  in  detail  purposes  and  conditions  of  this  Fund,  as  for  instance,  "  Principal 
or  Income  may  be  used  for  subscriptions  to  Periodicals,  or  for  Purchase  of  Apparatus 
or  Instruments  for  the  Pathological  Department." 
Dh.  Cb. 


Total  from  previous  month 
Appropriation  during 
month  for  expenses 
chargeable  to  this  Fund, 
as  reported  by  Superin- 
tendent, as  per  Journal 
Entry  4 


§Total  from  previous  month 

Donations  received  during 
month  for  this  Fund,  as 
per  Treasurer's  Cash  Book 

Cash  received  during  month, 
account  Income  from  in- 
vestments held  in  this 
Fund,  as  per  Treasurer's 
Cash  Book 

Amount  of  Income  from  In- 
vestments   held    in    this 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS  85 

20.     A.  B.  C.  PATHOLOGICAL  DEPT.  FUND  ACCOUNT— Contimied 
Dr.  Cr. 

Account  accrued  and  due 
during  month  and  unpaid 
and  transferred  to  "Ac- 
counts    Receivable,"     as 

per  Journal  Entry  18 

Value  of  Investments  given 
to  Hospital  during  month, 
for  this  Fund  as  per  Jour- 
nal Entry  9 

Total Total 

Difference  in  totals  equals  the  amount  of  this  Fund,  as  shown  on  Books  and 
on  Balance  Sheet. 

Note — The  general  Ledger  Accounts,  "Endowed  Bed  Fund,"  "General  En- 
dowment Fund"  or  other  similar  Funds,  the  income  from  investments  held  in 
which  is  to  be  used  only  to  meet  current  expenses  and  is  not  to  be  added  to  the 
principal,  are  intended  to  show  only  the  increase  or  decrease  of  the  principal  of 
Buch  Capital  Funds. 

The  investments  assigned  to  each  of  such  Funds  and  monthly  income  from 
same  is  shown  by  an  Income  Ledger  Account,  as  described  on  pages  95  and  96 
and  also  in  separate  General  Ledger  Accounts  referred  to  on  page  74. 

There  are  other  General  Ledger  Accounts  such  as  "X.  Y.  Z.  Visiting  Nursing 
Fund,"  "A.  B.  C.  Pathological  Department  Fund"  or  other  similar  Fund  Accounts 
in  which  the  income  from  investments  held  in  these  funda  as  it  falls  due,  is  to  be 
added  to  and  becomes  a  part  of  the  principal. 

Donations  towards  the  principal  of  such  Funds  and  income  from  investments 
which  may  be  held  in  such  Funds,  are  therefore  both  credited  to  such  General  Led- 
ger Fund  Accounts  and  it  is  not  necessary  in  such  cases  to  keep  additional  General 
Ledger  Accounts  to  show  the  income  only  from  such  Funds.  Income  Ledger 
Accounts,  however,  as  described  on  pages  95  and  96  are  kept  where  necessary  to 
show  a  list  of  investments  assigned  to  such  funds  and  the  monthly  income  from  same. 

21.  LOANS  AND  NOTES  PAYABLE  ACCOUNT 
Db.  Cb. 

Total  from  previous  month      §Total  from  previous  month     

Loans  paid  during  month,  as  Cash  received  during  month 

per  Treasurer's  Cash  Book     account  Loans»incurred,  as 

Loans   paid   during   month  per  Treasurer's  Cash  Book     

by  renewal,  by  signing  of  Loans     renewed     during 

new  notes,  and  cancella-  month  by  signing  of  new 

tion  of  old  notes,  as  per  notes  and  cancellation  of 

Journal  Entry  13 old  notes,  as  per  Journal 

Entry  13 

Total Total 

Difference  in  totals  equals  "Loans  and  Notes  Payable,"  as  shown  on  Books 
and  on  Balance  Sheet. 

Note — "Mortgages  Payable  Account"  may  be  treated  in  the  same  manner 
as  "  Loans  and  Notes  Payable  Account." 


86 


TREASURER'S  GENERAL  LEDGER  ACCOUNTS 


22.    SURPLUS  AND 
Db. 

fTotal  from  previous  month     

Grand  Total  Current  Ex- 
penses, Schedule  2,  during 
month,  as  per  Voucher 
Register,  as  reported  by 
Superintendent,  as  per 
Journal  Entry  3 

Total  Capital  Expenditures, 
Schedule  3,  during  month, 
as  per  Voucher  Register, 
as  reported  by  Superin- 
tendent, as  per  Journal 
Entrj'3 

Uncollectible  Superintend- 
ent's Accounts  Receiv- 
able charged  oS  during 
month,  as  reported  by 
Superintendent,  as  per 
Journal  Entry  3 

Uncollectible  Treasurer's 
Accounts  Receivable 
charged  off  during  month, 
as  per  Journal  Entry  16 

Loss  or  Depreciation  of 
General  Material  charged 
off  during  month,  as  re- 
ported by  Superintendent, 
as  per  Journal  Entry  3 

Loss  or  Depreciation 
charged  off  Investment 
Accounts  or  Current  Asset 
Accounts,  Schedule  4, 
during  month,  as  per 
Journal  Entry  10 

Amount  to  be  credited  to 
"  Capital  Account "  to  rep- 
resent increase  of  equity 
of  the  Hospital  in  its  Pro- 
perties and  Equipment 
by  reduction  of  Mortgages 
Payable  Account,  as  per 
Journal  Entry  23 


Total. 


DEFICIT  ACCOUNT 

jTotal  from  previous  month 

Grand  Total  Current  Revenue, 
Schedule  1,  during  month, 
as  per  Journal  Entry  4  . . . 

Profit  on  Bonds,  Stocks  or 
other  Investments  sold 
during  month,  as  per 
Income  Ledger,  as  per 
Journal  Entry  8 

Profit  on  sale  of  "Sites  and 
Grounds,"  "Buildings"  or 
other  Hospital  Properties 
and  Equipment,  as  per 
Journal  Entry  6 

Amount  charged  off  En- 
dowed Bed  Fund,  Partly 
Endowed  Bed  Fund,  or 
Other  Funds  during 
month,  accoimt  liability 
of  Hospital  having  ceased, 
as  per  Journal  Entry  12. . 

Surplus  amount  of  General 
Material  found  to  be  on 
hand  during  month  as  re- 
ported by  Superintendent, 
as  per  Joiu'nal  Entry  2. . . 

Unclaimed  Overpayments 
by  Patients,  as  per  Jour- 
nal Entry  2 

Unclaimed  TTages,  as  per 
Journal  Entry  2 

Book      Value      of      "Sites 
and  Grounds,"  "Buildings," 
"Furniture  and  Fixtures," 
"Machinery  and  Tools," 
"Apparatus  and    Instru- 
ments,"      "Ambulances, 
Live  Stock,  etc."  or  other 
"Hospital  Properties  and 
Equipment,"  Schedule  4, 
sold  during  the  month  or  for 
amount   collected    during 
month  from  Insurance  Com- 
panies for  such  properties 
damaged  or  destroyed  by 
fire,  as  per  Journal  Entry  19 
Total 


Cb. 


TREASURER'S  INCOME  LEDGER  ACCOUNTS  87 

Difference  in  totals  equals  "Surplus  or  Deficit"  to  date,  as  shown  on  Books  and 
on  Balance  Sheet. 

"Deficit  to  date,"  if  any,  up  to  the  amount  of  Reserve  Fund  Accounts  will 
represent  the  amoiint  Reserve  Fund  Accounts,  if  any,  have  been  encroached  upon. 

"Svirplus  to  date,"  if  any,  will  represent  the  amount  of  surplus,  which  the 
Hospital  has  to  its  credit,  not  including  the  value  of  any  of  its  plant,  which  goes 
to  make  up  "Hospital  Properties  and  Equipment." 

*At  the  first  of  each  fiscal  year,  under  the  headings  in  the  Treasurer's  General 
Ledger  of  any  of  the  accounts  referred  to  on  the  debit  side  of  the  Balance  Sheet 
(Schedule  4),  the  balance  sho-wn  on  the  debit  side  of  each  account  at  the  end  of  the 
previous  month  should  be  sho'ft'n  on  the  debit  side  only  as  "Balance  at  first  of 
year,"  instead  of  "Total  from  previous  month." 

§  At  the  first  of  each  fiscal  year  under  the  headings  in  the  Treasurer's  General 
Ledger  of  "Treasurer's  Account  with  Superintendent,"  and  any  of  the  accounts 
referred  to  on  the  credit  side  of  the  Balance  Sheet  (Schedule  4),  the  balance  shown 
on  the  credit  side  of  each  account  at  the  end  of  the  pre\-ious  month  should  be  shown 
on  the  credit  side  only  as  "  Balance  at  first  of  year  "  instead  of  "  Total  from  previous 
month." 

t  At  the  first  of  each  fiscal  year,  under  the  heading  in  the  Treasurer's  General 
Ledger  "Surplus  and  Deficit  Account,"  the  amount  of  the  "Surplus"  or  "Deficit 
to  date"  at  the  end  of  the  pre%aous  month  is  the  amount  which  should  be  shown 
on  the  credit  side  of  the  accoimt,  if  a  Surplus,  or  on  the  debit  side  of  the  account 
if  a  Deficit,  as  "Balance  at  first  of  Year,"  instead  of  "Total  from  previous  month." 

TREASURER'S  TRLAL  BALANCE 

The  Treasurer's  Trial  Balance  at  the  end  of  any  month  or  year 
is  simply  a  transcript  of  the  Balance  Sheet  (Schedule  4),  in  which, 
opposite  each  of  the  headings  shown  is  entered  the  balance  as 
shown  by  each  account  on  the  Treasurer's  General  Ledger  at  the 
end  of  such  month  and  in  lieu  of  the  balance  shoT^ni  by  Treasurer's 
Account  with  Superintendent  such  additional  information  from 
the  Superintendent's  Trial  Balance,  as  is  needed  to  complete  the 
Balance  Sheet.  Opposite  the  word  "Deficit"  on  the  debit  side, 
or  opposite  the  word  "Surplus"  on  the  credit  side  of  the  trial 
balance  must  be  entered  "Deficit  to  date"  or  "Surplus  to  date," 
as  the  case  may  be,  as  shown  by  the  "Surplus  and  Deficit"  ledger 
account.     The  final  totals  must  then  agree. 

TREASURER'S  INCOME  LEDGER  ACCOUNTS 

In  addition  to  the  "General  Ledger  Accounts"  referred  to  in 
the  preceding  pages,  the  Treasurer  should  also  keep  separate 
Income  Ledger  Accounts  with  each  kind  of  Bonds,  Stocks,  other 
Investments  owned  or  Loan  or  Mortgage  Receivable  or  Payable, 


88  TREASURER'SINCOME  LEDGER  ACCOUNTS 

SO  as  to  show  plainly  the  amount  of  the  principal  and  income 
or  expenses  on  account  of  each. 

In  order  to  show  what  securities  or  other  investments  are 
assigned  to  each  Fund  and  the  monthly  income  from  same,  sepa- 
rate Income  Ledger  Accounts  should  be  kept  for  each  of  these 
Fund  accounts.  The  income  as  it  accrues  is  posted  to  such  ac- 
counts from  the  Treasurer's  Cash  Book,  if  paid,  or  by  Journal 
Entry,  if  not  paid,  as  indicated  in  the  sample  of  such  an  account 
on  pages  95  and  96. 

These  Income  ledger  Accounts  do  not  form  any  part  of  the 
Treasurer's  Balance  Sheet  and  should  not  be  confused  with  the 
General  Ledger  Accounts. 

The  following  Ulustrations  will  show  how  entries  are  made  to 
such  accounts: 


TREASURER'S  INCOME  LEDGER  ACCOUNTS 


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PROVISION  FOR  AMORTIZATION  OR  ACCUMULATION 

ON  BONDS 

In  Hospital  Accounting  it  will  not  often  be  thought  worth 
while  to  go  into  what  might  be  called  the  technical  refinements 
of  accounting  and  to  consider  such  matters  as  amortization  and 
accumulation  on  bonds  for  the  reasons  that  comparatively  few 
hospitals  own  enough  bonds,  the  book  value  of  which  is  so  different 
from  the  par  value,  as  to  make  worth  while  the  extra  accounting 
involved.  There  would  not  seem  to  be  much  practical  necessity, 
therefore,  for  financial  officers  of  the  ordinary  hospital  to  consider 
such  matters  and,  to  avoid  what  seems  to  be  unnecessary  complica- 
tions in  hospital  accounting,  no  reference  has  been  made  to  any 
periodical  allowances  for  amortization  and  accumulation  in  the 
entries  referring  to  bonds  or  interest  thereon  on  the  books  of  the 
Treasurer  referred  to  in  this  volume. 

As  a  matter  of  information,  however,  for  those  who  may  not 
understand  what  is  meant  by  taking  care  of  amortization  and 
accumulation  on  bonds  the  following  brief  explanation  is  offered. 

AMORTIZATION 

Bonds  which  are  well  secured  or  which  bear  a  high  rate  of 
interest  command  a  better  price  than  those  issued  on  a  less 
favorable  basis  and  are  usually  sold  at  a  premium  where  both 
features  are  present.  As  the  amount  payable  to  the  bond-holder 
at  the  maturity  of  the  bond  is  the  par  value  it  may  be  desired  to 
adopt  some  method  to  write  off  the  premium  paid,  when  bonds  of 
a  market  value  much  above  par  are  purchased  by  or  are  given  to 
the  hospital. 

From  published  tables  it  is  easy  to  ascertain  the  amount  of 
amortization  or  accumulation  on  bonds  bearing  different  rates  of 
interest  and  having  certain  fixed  dates  of  maturity. 

The  method  of  writing  off  the  premium  would  be  to  treat  the 
interest  received  as  being  in  part  true  interest  and  in  part  a  return 
of  capital  invested  and  divide  it  accordingly,  properly  crediting 
that  part  of  the  cash  received  which  is  applicable  to  the  principal. 
For  instance,  if  the  market  rate  of  interest  is  43^%  a  $1000  bond 

97 


98  ACCUMULATION 

bearing  6%  interest  payable  semi-annually,  redeemable  at  par 
in  four  years,  will  command  a  premium  of  about  $54.40.  An 
investor  on  a  4}^%  basis  would  therefore  pay  $1054.40  for  the 
bond  and  receive  $60.00  a  year  nominal  interest  and  $1000  prin- 
cipal at  the  end  of  four  years. 

At  the  end  of  the  first  six  months  the  investor  will  divide  the 
$30.00  into  two  parts,  $23.70  net  income  at  say  43^%  on  the  book 
value  and  $6.30  return  of  original  investment.  This  amount 
representing  return  of  original  investment  would  be  credited  to 
"Bonds  Account"  on  the  Treasurer's  General  Ledger  and  would 
be  credited  to  reduce  the  book  value  of  the  particular  bond  con- 
cerned on  the  Treasurer's  Income  Ledger.  At  the  end  of  the  six 
months  the  book  value  of  the  investment  will  be  $1048.10.  This 
would  continue,  making  the  proper  allowance  for  amortization, 
until  the  bond  was  reduced  to  par  at  maturity. 

ACCUMULATION 

Bonds  which  do  not  bear  a  high  rate  of  interest  or  are  not  well 
secured  do  not  command  as  high  a  price  as  those  issued  on  a  more 
favorable  basis  and  where  both  features  are  present  the  bonds  are 
usually  sold  at  a  discount.  As  the  amount  payable  to  the  bond- 
holder at  maturity  of  the  bond  is  the  par  value,  it  may  be  desired 
to  adopt  some  method  to  periodically  credit  the  accumulation. 
The  accumulation  or  discount,  therefore,  is  properly  divided  in 
proportion  to  the  number  of  years  the  bond  is  to  run.  The  annual 
proportion  of  the  discount  is  added  to  the  true  interest  and  the 
total  is  considered  net  income  on  the  bond.  For  instance,  if  a 
$1000  bond  bearing  3%  interest  payable  semi-annually,  redeem- 
able at  par  in  four  years,  sells  on  a  4]/^%  interest  basis  it  will  sell 
at  a  discount  of  about  $54.40,  the  investor  paying  $945.60  for  the 
bond,  receiving  $30.00  a  year  nominal  interest  and  $1000  principal 
at  the  end  of  four  years. 

At  the  end  of  the  first  six  months  the  investor  will  add  to  the 
$15.00  cash  interest  at  3%,  $6.30  accumulation.  This  amount 
representing  accumulation  would  be  debited  to  Bonds  Account 
on  the  Treasurer's  General  Ledger  and  would  be  debited  to  in- 
crease the  book  value  of  the  particular  bond  concerned  on  the 
Treasurer's  Income  Ledger.  The  book  value  of  the  investment 
in  the  bond  at  the  end  of  the  first  six  months,  therefore,  will  be 
$951.90.  This  practice  will  continue  until  the  bond  is  increased 
to  par  at  maturity. 


TREASURER'S  ENDOWED  BED  LEDGER  ACCOUNTS 


99 


The  advantages  claimed  for  Amortization  and  Accumulation 
are  that  if  bonds  are  purchased  at  a  premium  or  a  discount 
the  par  value  is  shown  on  the  books  at  maturity,  thus  making  the 
book  value  more  nearly  represent  actual  value  and  obviating  the 
necessity  of  showing  the  loss  or  profit  on  redeeming  securities  if 
handled  otherwise  and  spreading  the  premium  or  discount  over 
the  number  of  years  the  bonds  are  held. 

TREASURER'S   ENDOWED   BED   LEDGER   ACCOUNTS 

At  the  Presbyterian  Hospital  the  Treasurer  keeps  in  a  separate 
Ledger  from  those  referred  to  heretofore  an  Endowed  Bed  Ledger 
Account  with  each  organization  which,  or  each  individual  who, 
fully  endows  a  bed  or  makes  payments  on  account  toward  such 
endowments. 

At  the  head  of  each  account  detailed  information  is  given  in 
regard  to  the  name  of  the  Organization  or  Individual  endowing 
the  bed,  and  whether  in  perpetuity  or  for  one  life,  etc.,  the  name 
the  bed  is  to  bear,  if  any  and  in  whose  memory  the  bed  is  endowed, 
its  certificate  number  and  any  other  information  pertinent. 

This  record  also  shows  the  name  and  address  of  the  OflBcer  of 
any  Organization  or  the  Individual  having  the  right  to  nominate 
patients  to  use  such  bed.  In  case  of  transfer  of  the  right  to  nomi- 
nate patients  by  death  of  the  nominor,  or  otherwise,  the  name  and 
address  of  his  or  her  successor  is  recorded  as  long  as  any  such 
nominor  exists  at  whose  request  the  Hospital  is  obligated  to  fur- 
nish free  treatment  to  patients. 

If  no  nominor  exists  having  the  right  to  name  patients  to  use 
an  endowed  bed  the  liability  of  the  Hospital  ceases  and  at  the 
Presbyterian  Hospital  it  is  then  customary,  with  approval  of  the 
Board  of  Managers,  in  each  case,  to  charge  off  the  amount  of  such 
endowment  from  Endowed  Bed  Fund  Account  at  the  end  of  the 
fiscal  year,  as  per  Journal  Entry  12. 

The  following  illustration  will  show  how  entries  are  made: 

In  Case  a  Bed  is  Fully  Endowed 
Db.  Cb. 

Cash  received  by  Treasurer, 
as  per  his  Cash  Book,  or 
amount  transferred  from 
Partly  Endowed  Bed 
Fund  account  completion 
of  such  endowment,  as  per 
Journal  Entry  11 


100  TREASURER'S  ENDOWED  BED  LEDGER  ACCOUNTS 

In  Case  a  Bed  is  Endowed  in  Pabt  Patments 

Db.  Cb. 

Total  from  previous  month      

Cash  received  by  Treasurer 
during  month,  partial 
payment  on  account,  as 
per  his  Cash  Book 

In  Case  a  Bed  has  been  Endowed  and  Liability  of  Hospital  has  Ceased 

Db.  Cb. 

Amount  charged  off  account  Total  of  such  endowment 

liability  of  Hospital  hav- 
ing ceased,  as  per  Journal 

Entry  12 

This  account  will  the/a  balance. 


THE  PRESBYTERIAN  HOSPITAL  in  the  City  of  New  York 
Statistics  of  Patients  for  Month  of  — 


Hospital  Ward*  and  Private  Room* 

Mnte 

Female 

Total 

Ambulance 

Patients  in  Hospital  First  of  Month  : 

Ambulance  Calls  during  month. 

In  Medical  Wards, 

Average  Calls  per  day, 

In  Surgical  Wards, 

Average  Cost  per  Ambulance  Call, 

In  Private  Rooms, 

Patients    Treated    by    Ambulance    Surgeon    in 

Total 

Emergency  Ward  and -Transferred, 

Patients  Abmitted  During  Month  ; 

Patients  Treated  by  Ambulance   Surgeon  and 

To  Medical  Wards, 

left  at  place  of  call  or  transferred  direct  to 

To  Surgical  Wards, 

other  Institutions  or  to  their  homes. 

To  Private  Rooms, 

Total 

Summary 

Total  Patients  Treated  in  Hospital  Wards 

Total  Patients  Treated  at  the  Hospital  during 

AND  Private  Rooms  During  Month  : 

month  in  all  departments. 

Patients  Discharged  During  Month  : 

Average  Patients  per  day  in  all  departments, 

Cured 

Daily  Average  Number  of  Employes  Boarded  in 

Improved 

Hospital, 

Unimproved 

Daily   Cost   per   capita    for    Provisions    for   all 

Transferred  to  other  institutions 

persons  supported. 

Died 

Total 

Social  Service  Department 

Patients  in  Hospital  End  of  Month  : 

Former  Cases  Cared  for,  who  have  not  been 

In  Medical  Wards, 

cared  for  in  any  previous  month  of  present 

In  Surgical  Wards, 

fiscal  year, 

In  Private  Rooms, 

Former  Cases  Cared  for,  who  have  been  cared 

Total 

for  in,  some  previous  month  of  present  fiscal 
New  Cases  Cared  for. 

Free  Ward 

Endowed  Bed 

P.iy  Wrtrd 

Private  Room 

Total 

Total  Patient  Days 

Treatment  : 

Total  Cases  Cared  for, 

Percentage  : 

Visits  to  Homes  for  Social  Service, 

Average  Patients 

Visits  to  Homes  of  Patients  for  Nursing  Care, 

PER  Day  : 

Visits  to  Ward  Patients  needing  Social  Service 
Care. 

Average  Days  per  Patient  in  Hospital 

Daily  Average  Cost  per  Private  Room  Patient 

Visits  Made  at  Social  Service  Office, 

Daily  Average  Cost  per  Ward  Patient 

Total  Visits, 

Former  Cases  Given  Material  Relief,  who  have 

not  received  such  relief  in  any  previous  month 

of  present  fiscal  year, 

Out-Patient  Department 

Male 

Female 

Total 

Former  Patients  Treated,  who  have  not  been 

treated    in    any    previous    month    of    present 

Former  Cases  Given  Material  Relief  who  have 

fiscal  year, 

received  such  relief  in  some  previous  month 

Former  Patients  Treated,  who  have  been  treated 

of  present  fiscal  year, 

in  some  previous  month  of  present  fiscal  year. 

New  Cases  Given  Material  Relief. 

Patients   Treated,   who   were   transferred    from 

Total  Cases  given  Material  Relief, 

other  departments  of  0.  P   D. 

Cases    referred  to  Organizations   for  Material 

New  Patients  Treated, 

Relief  or  Employment, 

Total  Patients  Treated, 

Patients    sent    to    Convalescent    Homes    and 

Sanatoria, 
Patients  sent  to  Hospitals,  Homes  for  Incurables 

and  Aged. 

Free 

P*r 

Total 

Visits  Made. 

Average  Visits  per  day, 

Patients  sent  to  Fresh  Air  Homes, 

Average  Visits  per  Patient^ 

Average  Cost  per  Visit, 

Patients  Receiving  Surgical  Dressings, 

Prescriptions  Filled, 

EXHI 

BIT  1  8 

.ze  8^" 

X  10^" 

[This  Form  should  have  faintly-ruled  h 


They   have   been  omitted  here  for  the  sake  of  cle 


FORMS  USED  IN  COMPUTING  STATISTICS  CONCERN- 
ING NUMBERS  OF  PATIENTS  TREATED,  DAYS 
TREATMENT,  VISITS,  ETC.,  REFERRED  TO  IN 
SCHEDULE  6,  ON  PAGES  11,  12  AND  13 

It  is  thought  that  the  followmg  description  and  illustrations 
of  forms  used  by  the  Presbyterian  Hospital  in  New  York  to 
show  and  to  compute  certain  statistics  concerning  patients  cared 
for  in  its  Hospital  and  in  its  Out-Patient  and  Social  Service  De- 
partments may  be  of  interest  to  hospital  officials. 

The  use  of  such  forms  has  simplified  and  minimized  the  labor 
of  securing  the  results  desired.  It  might,  of  course,  be  desirable 
to  modify  some  of  the  details  shown  to  better  suit  particular  re- 
quirements of  certain  institutions,  but  it  is  thought  that  the  meth- 
ods described  could  be  used  advantageously  by  many  hospitals. 

At  the  Presbyterian  Hospital  such  a  statement  as  is  illustrated 
by  "Exhibit  1 "  is  made  up  at  the  first  of  each  month,  and  such  a 
statement  as  is  illustrated  by  "Schedule  6"  is  made  up  at  the 
first  of  each  fiscal  year,  to  show  the  information  called  for  thereon 
concerning  patients  cared  for,  etc.,  during  the  previous  month  or 
year. 

The  other  forms  described  below  are  used  in  obtaining  the 
information  required  to  complete  "Exhibit  1,"  and  some  addi- 
tional information  of  interest  connected  more  or  less  closely 
therewith. 

HOSPITAL  PATIENTS  STATISTICS 

"Exhibit  2,"  is  printed  the  same  on  both  sides,  and  a  separate 
page  is  used  for  the  Medical  Wards,  for  the  Surgical  Wards,  and 
for  the  Private  Rooms  in  the  Hospital.  On  these  forms  the 
Superintendent's  clerk  enters  each  day  the  information  called 
for  by  the  headings.  At  the  end  of  each  month  the  totals  of  each 
column  are  obtained  and  are  entered  in  the  proper  places  on 
"Exhibit  1." 

"Exhibit  3,"  a  card  entitled  "Pedigree  of  Patient,"  is  printed 

101 


102 


PEDIGREE  CARDS 


differently  on  each  side.     On  one  side  the  information  called  for 
is  filled  in  by  the  clerk  in  the  Superintendent's  office  and  on  the 


KJ  lOM-8-17 

Pedigree  of  Patient 

Name 

Address 

Age                       Birthplace 
Mo          0«.         Yr. 

Occupation                                                  Religion 

STsi'to                     In  the  U.  a 
?l??S'"co                  In  the  Cilv 

Years                         Previous  Hospital  Treatment 
Years 

Father's  Name 

Birthplace 

Mother's  Maiden  Name 

Birthplace 

Name                                       Nearest  Relative  to  w«o«  ■•iict  tMOuio  u.sckt  m  on  or  ttmous  illkus.               Relation 

Address 

Name 

■           _                                                Roltt'ion 

EXHIBIT  5 

^''"'"       Size  6"  X 

4*  printed  differently  on  each  side 

Recommended  to  Hospital  by 

Admitted  to  Emergency  Ward 
Date                                        Time 

Treatment 
A.  P    M 

Pedigree  taken  by 

Sent  to  Ward 

O-PERSON  TAKINa  reDIAREB  WILL  WRITC  ON  THIS  SIDE  ONLVM 

other  side  the  diagnosis,  etc.,  is  filled  in  by  the  examining  physi- 
cian for  each  patient  admitted  to  the  Hospital.     These  pedigree 


Name                                                                                                                   Location            Division            CItst 

M.     S. 

ADMISSION 

DISCHARGE 

Date                                                         Time              A.~P   U. 

Date                                                 Rvsulta 

Diacnosls 

Diaenoeia 

Discharged  by 

1  have  examined  this  oatient  and  find  h 

M.  0 

a  proper  tuliject  for  treatment  in  the  hospital. 

Remarks 

txAwnmo  mtsicuui 

EXHTBTT  ^ 

reverse  side 

Hospital  No, 

cards  are  kept  on  file  in  the  Superintendent's  office  for  future 
reference. 


Statistics  of  Patients 

In 

Diirinn 

I< 

31 

MALE  PATIENTS 

FEMALE  PATIENTS 

PATIENT  DAVS  TREATMENT 

DISCHARGED 

DISCHARQED 

TOTAL 
PATIENTS 

PATIENTS 
REMAININO 

OENERAL 

ENDOWED   BED 

Total  Dan 
Treatment  0 

Date 

Adm. 

C. 

-■ 

U. 

T. 

D. 

Total 

Adm. 

C. 

"• 

U. 

T. 

D. 

Total 

Mm. 

Dis- 
charged 

Be- 
lecled 

Male 

Female 

Total 

Remain- 

Adm. 

Total 

Remain 
ins 

Adm. 

Total 

GRAND 
TOTAL 

PatlenlE 

I 

2 

3 

5 

~ 

6 

9 

10 

13 

14 

18 

19 

20 

21 

26 

27 

F 

XH 

iPT' 

P1' 

ift 

10 

'  r 

a' 

Pl 

mt 

jd 

jam 

0] 

1  bo 

th 

jld, 

IS 

31 

Total 

Day 

Ll 

_ 

1 

__. 

__ 

;^_. 

^_^ 

___ 

= 



BEDSIDE  CARDS 


103 


"Exhibit  4,"  a  card  entitled  "Bedside  Card"  is  printed  differ- 
ently on  each  side,  as  shown.  This  card  remains  with  the  history 
of  the  patient,  while  the  patient  is  in  the  Hospital,  and  when  the 


BEDSIDE     CARD 


simiLE.  HAHitp.  »inowio.  5i!»«»TtD.  orvoncrD 


ftesuLT"  cuteo.  improvcd.  uhimmovcd.  died. 


EXHIBIT 


4  size  5"  X  3' 


TRAHSFEIIBSD  1 


printed  dlffei'entlv  on  each  aide 


fHAHSPOrrgp  TO 


OISCM*B<^EO   FBOM 


•'-^"    «»-«i<-u» 


Kouic  smcioii 


patient  is  discharged  the  entries  called  for  on  the  card  are  com- 
pleted by  the  House  Physician  or  Surgeon,  and  the  card  is  promptly 
sent  to  the  Superintendent's  office. 


MACNOStS 

trrcNOiiG  m  CHA>ec  or  casi. 

OPCirATlONS 

EXHIBIT  4  Pdverae   side 

COHTAUIIIATCDCLU* 

niKAIT  umoK 

■OUHD    HULIIIS     SIACIOSIS 

tccomAt*  unioa 

FOLLOW  ur  DATI 

From  these  bedside  cards  sent  to  his  office  daily,  the  Super- 
intendent's clerk  obtains  the  information  needed  to  complete  the 
pedigree  cards,  as  regards  discharged  patients,  and  to  insert  on 


104        NURSE'S  REPORT  OF  ADMISSIONS  AND  DISCHARGES 

form  referred  to  as  "Exhibit  2"  the  information  called  for  regard- 
ing number  of  patients  discharged  and  number  of  days  treatment 
of  discharged  patients. 

When  this  information  has  been  thus  recorded,  these  bedside 
cards  are  sent  to  the  history  room,  where  they  are  used  as  name 
index  cards  of  the  history  file. 

In  case  a  patient  is  examined  for  admission  to  the  Hospital 
and  is  rejected  the  results  of  such  examination  and  cause  of  rejec- 
tion are  noted  on  a  history  form  and  such  histories  are  filed  in  a 
rejected  patient's  history  file  for  future  reference  after  the  munber 
of  patients  rejected  each  day  has  been  noted  on  Exhibit  2. 

By  properly  sorting  these  pedigree  and  bedside  cards  the 
Superintendent's  clerk  learns  how  many  male  or  female  patients 
have  been  admitted  to,  or  discharged  from  the  Medical  or  Surgi- 
cal Wards  or  Private  Rooms  of  the  Hospital,  and  thereby  ob- 
tains the  information  necessary  to  complete  the  daily  entries  on 
"Exhibits  2." 

"Exhibit  5"  illustrates  a  form  on  which  the  head  nurse  of 
each  Ward  or  group  of  Private  Rooms  reports  daily  to  the  Super- 
intendent's office  the  names  of  patients  admitted  to,  or  discharged 
from,  and  the  number  of  patients  remaining  in  such  section  of  the 
Hospital  for  the  twenty-four  hours  ending  at  midnight.  These 
reports  of  nurses  are  used  to  check  receipt  of  bedside  cards  of 
discharged  patients,  Exhibit  4,  to  verify  the  figures  entered  on 
"Exhibit  2"  and  to  check  the  Census  Book  referred  to  below. 

Census  of  Patients  Book 

At  the  Presbyterian  Hospital  it  has  been  found  desirable  to 
keep  in  the  Superintendent's  office  a  "Census  of  Patients"  book 
made  of  leather  with  space  assigned  for  each  ward  or  group  of 
private  rooms  about  as  indicated  on  "Exhibit  6." 

The  numbers  (or  letters)  shown  in  the  center  columns  refer 
to  beds  (or  private  rooms).  When  a  patient  is  admitted  to  the 
Hospital  a  small  card  %"  x  2%"  is  made  out  bearing  the  name  of 
the  patient  and  is  inserted  in  the  census  book  on  the  proper  page 
to  indicate  that  a  bed  or  room  in  that  section  of  the  Hospital  is 
occupied  by  the  patient  named. 

Blue  cards  are  used  to  indicate  endowed  bed  ward  patients 
and  white  cards  to  indicate  other  ward  patients.  Buff  cards  are 
used  to  indicate  private  room  patients. 


NURSE'S  DAILY  REPORT  OF 
PATIENTS  ADMITTED  AND  DISCHARGED 

This  Report  must  be  filled  out  by  the  Nurse  in  charge  of  each  Ward  or 
group  of  Private  Rooms  and  must  be  delivered  to  the  Superintendent's  Office 
not  later  than  eight  A.  M. 

Give  names  In  full  of  all  admitted  and  discharged. 


12:00  Midnight  - . 


191 


Ward  Number - 

Private  Room  Group  - — 

Patients  remaining  as  shown  by  last  report.. 


Admitted  Since 

Discharged  Since 

EXHTBTT  5  si 

ze  si"  X  8i" 

Number  of  Patients  remaining.. 


M 


w 

fe; 

O  CO 

w 

H>p 

c 

3 

WW 

i-"o 

o 

(D   M 

oo 

(B    A 

p^'^ 

r* 

ts-W 

>Tl 

fl)  O 

l> 

•m 

H 

<b 

M 

i 

•-3 

CO 

T' 


o% 


y\ 


-+- 


l_ 


t 


-t 


-L 


T' 


J L 


margin   for  binding 


CENSUS  OF  PATIENTS  BOOK  105 

If  a  page  of  the  census  book  has,  as  shown  on  "Exhibit  6," 
spaces  for  holding  thirty  small  cards  and  if  the  normal  capacity 
of  the  ward  referred  to  is  only  twenty-four  beds,  it  has  been 
found  desirable  to  attach  a  small  seal  or  paster,  as  indicated 
opposite  number  twenty-five,  to  show  that  if  cards  bearing  names 
of  patients  are  inserted  opposite  any  of  the  numbers  higher  than 
twenty-four  it  means  that  such  patients  are  temporarily  occupy- 
ing extra  beds  or  cots  in  such  ward. 

Thus  by  a  glance  at  any  page  of  the  census  book  it  is  possible 
to  see  quickly  just  how  many  beds  are  occupied  or  available  in 
that  section  of  the  Hospital,  The  Superintendent's  clerk  also  uses 
the  census  book  to  check  the  nurses'  daily  reports,  Exhibit  5  and 
the  figures  he  inserts  on  Exhibit  2,  to  show  the  number  of  patients 
remaining  each  day  in  the  different  branches  of  the  service. 

While  a  leather  census  book  such  as  that  described,  made  to 
order,  is  much  more  expensive  in  first  cost  than  certain  kinds  of 
ready  made  patent  card  indices  that  might  answer  the  pm-pose, 
it  is  thought  that  the  book  in  the  long  rxm  will  be  found  most 
satisfactory  and  convenient  and  can  be  more  easily  handled.  It 
should  last  for  ten  years  unless  it  becomes  obsolete  sooner  on  ac- 
count of  radical  changes  in,  or  enlargements  of  the  hospital. 

When  the  small  ^"  x  2%"  cards  bearing  the  patient's  name 
are  inserted  in  the  census  book  it  has  been  found  desirable  to  note 
the  date  of  admission  on  the  right  end  of  the  card  if  the  patient 
is  able  to  pay  for  treatment  and  on  the  left  end  of  the  card  if 
it  is  thought  that  the  patient  is  not  or  may  not  be  able  to  pay  for 
treatment. 

By  this  plan  the  Superintendent,  or  his  clerk,  can  see  by  a 
glance  at  the  census  book  which  patients  are  free  and  which  are 
pay;  but  if  doctors,  nurses  or  patients  happen  to  see  this  census 
book  they  cannot  tell  which  are  free  or  pay  patients  and  it  is  not 
desirable  that  they  should  have  this  information. 

On  the  back  of  the  small  cards  referred  to  the  Superintendent's 
clerk  sometimes  makes  notations  in  regard  to  promises  to  pay  or 
other  information  concerning  patients  whose  payments  may  be 
doubtful,  as  these  memoranda  may  be  useful  later  in  collecting 
bills. 

Clothes  Cards 

When  patients  are  admitted  to  the  Hospital  it  is  customary 
for  the  nurse  to  make  a  list  of  their  clothing  as  well  as  of  any  valu- 


106 


CLOTHES  CARDS 


ables  to  be  cared  for,  on  white  cards  provided  for  that  purpose 
called  "Clothes  Cards"  as  shown  by  "Exhibit  7,"  for  female 


Un  AOluTTtO 


CLOTHING  LIST 

(hOT£   0*1   OTMlft  Sioe   LIST  OF  AflTtClXS   TUEH   TO  OFPlCe) 


Skirt  (dress) 


Coat 


Handkerchiefs 


Stockings 


Collar 


Hat 


Undervest 


Corset 


Nightgov/n 


Corset  Cover 


Petticoat 


Drawers 


Shoes 


Mii  bf 


Uttiitt  la  Win  kr 


Date  taken  to  bake  room  Received  in  mortuary  by 

Received  from  the  Kesbyterian  Hospital-  in  the  City  of  New  York,  in  good  conditfon,  the" 
articles  mentioned  abovei 


gXHTBTT  7  fllzfl   f;"   Y  ^' 


D«te 


itrlntftd  dliyarently  on  «&eh  aide 


«■  use  iHK  nty  y  WHEM  writins  on  this  cawp  -q  , 


LIST    OF    ARTICLES    TAKEN    TO    OFFICE 

1 

1 

j 

EXHIBIT  7  reverse   Bide 

1                                              1 

1 

Dollars 

Brought  to  office  by 

Received  in  office  by                                                                                             Date 

Received  from  the  Presbyterian  Hospital  in  the  City  of  New  York  in  good  condition 
J  aiiicles  men'ioned  above,  and 
I  aflicles  mentioned  on  other  side 

"*"' 

Date  ; 

ar    USE  INK  ONLY  WHtti  WRITINQ  ON  THIS  CARD    -« 

patients,  and  on  buflF  cards  as  shown  by  "Exhibit  8"  for  male 
patients. 


CLOTHES  CARDS 


lor 


The  clothes  cards  are  kept  on  file  in  the  Superintendent's 
office  and  when  a  patient  is  to  leave  the  Hospital  his  clothes  and 
valuables  are  returned  to  him  and  he  is  asked  to  sign  receipts  for 
them  in  the  places  provided  therefor  on  the  clothes  card. 


OATE  ADurrrco 


CLOTHING  LIST 


Collar 


Trou?ers 


Overcoat 


Shirt 


Handkerchief 


Socks 


SuBpendera 


Uttftti 


RicilTtl  lo  Wir<  tj 


Date  taken  to  bake  room  Received  in  mortuary  by 

Received  from  the  Presbyterian  Hospital  in  the  City  of  New  York,  in  good  condition,  the 
articles  ntentioned  above.      FYTTTBIT  8  8189  6*  x  4* 


prirtt^^id  di^far'antly  op  iifcch  aidft 


PftVarHft   Bidet   aaaig   aa  i><>vwr«i>   mi  Am   at  ByMh-H:  7 


jg.     i»riUH  nxiv  WMr»n«iiTiMttr.ti  THIS  CAWP    •«» 


When  a  clothes  card  is  made  out  it  has  been  found  convenient  to 
stamp  by  a  rubber  stamp  the  letters  c,  c.  on  the  face  of  the  small 
^"  X  2%"  card  used  in  the  Census  Book  for  the  patient  con- 
cerned to  indicate  that  the  nurse  has  taken  the  patient's  clothes 
to  the  proper  store  room,  and  the  patient's  valuables,  if  any,  to 
the  Superintendent's  office,  and  that  a  clothes  card  has  been  made 
out  and  filed  in  the  Superintendent's  office.  This  c.  c.  also  re- 
minds the  clerk  in  the  Superintendent's  office  to  see  that  when 
the  patient  is  discharged  his  clothes  and  valuables  are  returned 
and  are  properly  receipted  for  on  the  clothes  card  by  the  patient. 

Receipts  for  clothes  or  valuables  are  given  to  patients  only 
when  requested  by  them  and  the  surrender  of  such  receipts  are 
requested  when  clothing  or  valuables  are  returned  to  the  patient. 

When  patients  are  discharged  from  the  Hospital,  or  die,  the 
Superintendent's  clerk  takes  the  small  cards  bearing  these  patients' 
names  from  the  census  book  and  makes  a  notation  on  each  card 
as  to  whether  the  patient  is  cured,  improved,  unimproved,  or 
has  died,  and  the  number  of  the  Ward  or  Private  Room  feom  which 
the  patient  came. 


108  COST  PER  PATIENT  PER  DAY 

These  small  cards  are  then  sent  to  the  information  clerk  at 
the  front  entrance  of  the  Hospital,  who  corrects  her  list  showing 
names  and  locations  of  patients  in  the  Hospital  accordingly  and 
notes  the  condition  in  which  the  patient  left,  so  that  she  can 
reply  properly  to  further  inquiries. 

These  small  cards  are  then  returned  to  the  Superintendent's 
clerk,  who  uses  them  to  remind  him  to  see  that  the  accounts  of 
all  discharged  patients  are  promptly  written  up,  if  this  has  not 
already  been  done,  and  in  the  case  of  endowed  bed  patients  to 
notify  the  owners  of  the  endowed  bed  that  the  patient  who  had 
occupied  such  bed  had  left  the  Hospital.  When  the  small  cards 
have  served  these  purposes  they  are  thrown  away. 

Pay  and  Free  Ward  Patient  Days  Treatment 

The  number  of  pay  ward  patient  days  treatment  referred  to 
on  "  Exhibit  1 "  is  obtained  by  dividing  the  total  amount  earned 
from  board  and  attendance  of  pay  ward  patients  during  the 
month,  as  shown  by  the  Bill  Register  (described  on  page  35), 
by  the  full  rate  per  day  charged  for  pay  ward  patients  (at  present 
$2.00  at  the  Presbyterian  Hospital). 

The  number  of  free  ward  patient  days  treatment  is  obtained 
by  subtracting  the  pay  ward  patient  days  treatment  plus  the 
endowed  bed  patient  days  treatment  from  the  total  ward  patient 
days  treatment  shown  by  "Exhibits  2." 

Cost  per  Patient  per  Day 

The  average  cost  per  patient  per  day  and  per  visit  referred  to 
on  "Exhibit  1"  are  figured  as  described  on  the  opposite  page,  but 
it  would  ordinarily  hardly  seem  worth  while  to  figure  these  of  tener 
than  twice  a  year. 

The  labor  involved  in  such  computations  is  considerable  and 
average  costs  per  day  for  a  period  of  less  than  six  months  might 
give  misleading  results  due  to  monthly  fluctuations  in  current 
expenses  for  certain  special  causes  and  also  because  at  times 
expenses  properly  chargeable  to  one  month  may  not  be  charged 
in  the  accounts  until  a  subsequent  month. 

OUT-PATIENT  DEPARTMENT  STATISTICS 

In  order  to  obtain  the  information  called  for  on  Exhibit  1  as 
regards  patients  treated  in  the  Out-Patient  Department  and 
also  as  regards  patients  treated  in  each  of  the  different  Clinics  of 
the  Out-Patient  Department  (which  includes  the  Emergency 
W^ard)  the  forms  described  below  have  proved  very  satisfactory. 


STATEMENT  SHOWING  METHOD  OF  FIGURING  "COST  PER  PATIENT  PER  DAY"  AT  THE  PRESBYTERIAN  HOSPITAL 

Fcrr  Year  Ending  September  30,  1907  {Not  Including  Corporation  Expenses) 


Administration  Expenses 

Professional  Care  of  Patients: 

Supt.  of  Nurses,  Assistants  and  Instructors . 


Nurses 

Special  Nurses 

Orderlies 

Ward  Employees 

Equipment  for  Nurses 

Medical  and  Surgical  Supplies  . 

Dispensary,  Matron 

Dispensary 

Emergency  Ward 

Visiting  and  Home  Nursing 

X  Ray  Service 

Ambulance 

Pathological  Department 

Housekeeping 

Kitchen 

Laundry 

Steward's  Department 


General  House  and  Property  Expenses. 


Total  Operating  Expenses 

Total  Patient  Days'  Treatment  and  visits' 
Cost  per  Patient  per  Day 


100% 
$18,113.56 

100% 
3,978.96 

100% 
6,879.05 

100% 
17,149.00 

100% 
5,465.70 

100%, 
1,980.95 

100% 
2,347.11 

100% 
18,712.93 

100% 

600.00 

100% 
8,768.83 

100% 
3,865.58 

100% 
9,461.42 

100% 
1,122.58 

100%, 
6,135.99 

100% 
6,585.85 

100% 
31,407.06 

100%, 
8,473.82 

100% 
7,142.22 

100% 
66,070.71 

100% 
29,045.27 


Ward 
Patients 


82% 
$14,853.12 

82%, 

3,262.75 

actual  cost 

4,782.10 

actual  cost 

3,408.00 

actual  cost 

4,238.87 

actual  cost 

1,633.45 

87  2/10%, 

2,047.15 

92%, 
17,215.90 
23%o 
138.00 


35% 
392.90 
22  5/10% 
1,380.60 

84% 

5,532.11 

88  5/10%, 

27,795.25 

82%, 

6,948.53 

85  5/10%, 

6,106.60 

82% 

54,177.98 

88% 
25,559.84 


$179,473.15 
74,013 


Cost  per  Ward 

Patient  per 

Day 


.20 

.044 
.065 
.046 
.C57 
.022 
.028 
.233 
.002 


.005 
.019 
.075 
.376 
.094 
.082 
.732 
.345 


2.42  S/10 


Private  Room 
Patients 


Cost  Per  Pri- 
vate Room  Pa- 
tient per  day 


$1,811.36 

10%o 

397.89 

actual  cost 

2,096.95 

actual  cost 

13.741.00 

actual  cost 

1,226.83 

actual  cost 

347.50 

5  6/10% 

130.50 

8% 

1,497.03 

12.00 


5% 
56.13 


526.87 

9%o 

2,826.64 

15% 
1,271.07 
9% 
642.80 
15% 
9,910.60 

5% 
1,452.26 


37,947.43 
6,383 


$     .284 

.062 
.329 
2.153 
.192 
.054 
.02 
.234 
.002 


.083 
.443 
.199 
.10 
1.552 
.229 


i.94  5/10 


Dispensary 


0% 
$905.68 


:  8/io%o 
65.25 


75% 

450.00 

100% 

!,768'.83 


20% 
224.52 


526.87 

1% 
314.07 

1% 
84.74 

2% 
142.84 

1% 
660.71 


$13,794.72 
86,172 
$0.16 


Emergency 
Ward 


3% 
$543.40 


3% 
119.37 


4  4/10% 
104.21 


100%o 
3,865.58 


40% 
449.03 
77  5/10%, 
4,755,39 


1% 
314.07 

1% 
84.74 

3% 
214.27 

1%) 

660.71 

1  5/10% 

435.68 


$11,546.45 

29,305 
80.39  4/10 


Visiting  and 
Home  Nursing 


treated?    ^  ''"^^  °      peratmg  Room  Nurses  and  Operating  Room  Orderlies  are  distributed  in  proportion  to  the  numbers  of  Private  Room  Surgical  Patients  and  Ward  Surgical  Patients 

The  method  in  use  at  The  P  e  bvt  '  H  •  i  f'"''™°°  "'^  Figuring  Cost  of  Different  Branches  of  the  Service. 
homes  is  to  charge  each  branch  oVthe  senice  wXtawSYnM^  ^^^  *°*f'  n"^*  °^  "^""^^  f°''  fZ^M  ^^'"^^  ^°°i°'  Dispensary,  Emergency  Ward  Patients  or  Patients  visited  in  their 
operating  expenses,  which  contribute  trthecort  of  ?hlHfffotT^^''u^ '''I P'''^'?'^'^'^P^°y''t  eMiusively  m,  and  all  supplies  and  repaire  directly  chargeable  to,  such  service.  Other 
after  careful  consideration  of  the  local  conditions  whiph  »  «  f  ''^  "^  of  service  are  prorated  m  such  proportion  as  the  Superintendent  and  his  Assistants  may  consider  most  fair 
fessional  Care  of  Patients,  Housekeeping  Kitchen  ^nH  n?h»'.  ''°"''"''  ^"bj.ect  to  change  f™m '■  me  to  time.  In  determining  the  relative  proportion  of  Administration  Expenses,  Pro- 
the  percentage  charged  to  Ward  PatiLtf'and  to  Private  RoLSt,w'°°K'°''i"'^'°*^  V'vf  ""^.mber  I'r:?"^?^^'^'^^'^'"  *°  Dispensary,  Emergency  Ward  and  Visiting  and  HomeNursing, 
instance,  the  fact  that  a  private  room  patient  reou[^rmnrr.  J     -^^^^  Thf,  ^  1"^^^    treatment  furnished  in  each   service,  modified  by  well-known  facts.    For 

more  than  that  of  the  ward  patient.    TrdistriSuiion  nf  fh^nn  f 'J"^'  care  than  necessary  >f  bf  were  located  in  a  ward;  also  that  his  food  and  the  preparation  of  it  costs  very  much 
contents  of  those  parts  of  the  buildings  occupied  by  eLh  of  the  fi  "^  t"'*"  7    ^'"P^'^^  Expenses  among  the  different  branches  of  the  service  is  based  upon  the  relative  cubic 


OUT-PATIENT  DEPARTMENT  STATISTICS 


109 


As  new  patients  come  for  the  first  time  to  the  Out-Patient 
Department  for  treatment  they  are  given  as  they  enter  a  small 

round  piece  of  cardboard  Ire  inches 
in  diameter,  bearing  a  sequence  num- 
ber, as  shown  herewith,  so  that  in  the 
order  of  their  arrival  they  may  be  ex- 
amined by  the  Chief  of  Clinic  or  his 
Assistant  for  assignment  to  the  proper 
Clinic. 

WTien  the  Chief  of  Clinic  has  ques- 
tioned and  made  a  provisional  diag- 
nosis of  a  new  patient  he  notes  on  a 
small  piece  of  paper  the  number  of  the 
room  in  which  the  clinic  is  held  to  which  the  patient  is  assigned. 
The  patient  then  takes  this  paper  to  the  admitting  clerk  who 
gives  the  patient  an  Identification  Card  printed  on  both  sides,  as 
shown  by  "Exhibit  9."     This  card  conforms  with  the  require- 


NO „ , 

THE     PRESBYTERIAN     HOSPITAL 

OUT   PATIENT   DEPARTMENT 
Madison  Avenue  and  70th  Street 


NAME „..._ _ AGE 

EXHIBIT  9  slae  3^"x  25/8" 

Surgical  Patients,  9  to  10  A.M. 
Medical  Patients,  1.30  to  2.30  P.M. 

COVER^ 


00 


o 


ments  of  the  New  York  State  Board  of  Charities.  If  a  patient 
loses  this  Identification  Card  it  has  been  found  desirable  to  make 
an  extra  charge  of  ten  cents  for  a  new  card,  so  as  to  make  patients 
careful  of  their  cards. 

The  Clerk  also  makes  out  a  Name  Index  Card  of  such  patient, 
for  the  Out-Patient  Department  history  file,  as  shown  by  "  Exhi- 
bit 10,"  printed  on  one  side  only. 

The  clerk  also  gives  the  new  patient  a  small  cardboard  sequence 


110 


OUT-PATIENT  DEPARTMENT  STATISTICS 


letter  showing  the  room  number  of  the  clinic  to  which  he  is  as- 
signed and  the  sequence  in  which  he  is  to  receive  treatment. 


, 

Penalty  for  False  Representations. 

Section  296,  Chapter  55,  Consolidated  Laws. 

"Any  person  who  obtains  medical  or  surgi- 
cal treatment  on  false  representations  from  any 
dispensary  licensed  under  the  provisions  of  this 
ac^   shall  be  guilty  of  a  misdemeanor,  and  on 
conviction  thereof  shall  be  punished  by  a  fine  of 
not  less   than  ten  dollars  and  not  more  than 
two  hundred  and  fifty  dollars." 

(Imprisonment  until  fine  be  paid  may  be  im- 
posed.   Code  Crim.  Pro.,  Sec.  718.) 

223-lSM-«-l7 

EXHIBIT  9  r«Terse  side 

When  the  new  patient  is  examined  in  the  clinic  his  history 
is  made  out.    This  history  is  kept  on  file  in  the  Out-Patient  De- 


«MK 

MO. 

AQ* 

TIAII* 

•CCtfPATlOa 

•  IRTMPLACC                                                       1 

MOHTMS 

• 

>Aiicai 

rAOC 

■AL.a 

rCMALI 

WMITC 
■  LACK 

•mOLe 
■AimiiB 

WIOOWIO 
StFAMATCO 

OATK 

DEPARTMENT 

EXHIBIT  10  slBe 

5" 

X 

3" 

partment  unless  the  patient  is  transferred  to  a  ward  in  the  Hos- 
pital, in  which  case  the  history  follows  him. 

After  his  first  visit,  when  a  patient  returns  to  the  Out-Patient 
Department  with  his  Identification  Card,  Exhibit  9,  he  calls  at 
the  clerk's  oflBce  and  receives  a  small  cardboard  sequence  number 


OUT-PATIENT  DEPARTMENT  STATISTICS  111 

showing  the  room  number  of  the  clinic  to  which  he  is  assigned 
and  the  sequence,  as  indicated  by  the  number,  in  which  he  is  to 


receive  treatment.  The  clerk  also  sends  the  history  of  the  patient 
to  the  clinic  to  which  the  patient  is  assigned. 

It  has  been  found  desirable  to  give  patients  coming  to  the 
Out-Patient  Department  for  the  first  time  cardboard  sequence 
letters  and  on  subsequent  visits  to  give  them  cardboard  sequence 
numbers,  so  that  if  the  doctor  in  charge  of  the  clinic  should  so 
desire,  those  who  have  been  to  the  Out-Patient  Department  before 
may  have  preference  in  the  order  of  their  treatment,  and  also  to 
facilitate  counting  the  new  patients  and  checking  the  numbers  of 
new  patients  treated,  as  posted  from  the  histories  to  "  Exhibit  11. " 

The  reason  why  at  times  it  may  be  desirable  to  give  preference 
to  former  patients  is  because  ordinarily  it  requires  more  time  and 
care  to  examine  a  patient  and  make  out  his  history  for  the  first 
time  than  at  subsequent  visits.  Therefore,  if  the  patients,  who 
have  been  examined  and  treated  before  are  given  attention  first 
the  aggregate  delays  to  patients  will  probably  be  minimized. 

Cardboard  sequence  numbers  and  letters  for  the  same  clinic 
have  a  distinctive  color  different  from  the  colors  used  for  any  other 
clinic  and  those  not  already  distributed  to  patients  each  day  are 
kept  arranged  in  proper  order  in  a  wooden  holder  made  of  a  block 
of  wood  bored  with  holes  about  one  and  one  half  inches  in  diameter 


as  shown.  Thus  by  a  glance  at  the  number  or  letter  next  in  order 
the  clerk  can  see  just  how  many  patients  have  visited  any  clinic 
that  day  up  to  that  time. 


112  OUT-PATIENT  DEPARTMENT  STATISTICS 

These  pieces  of  cardboard  have  a  one -eighth -inch  hole  punched 
in  the  center  so  that  if  desired  they  can  be  placed  on  a  spike 
holder  or  strung  together  on  a  string. 

By  means  of  the  sequence  numbers  and  letters  distributed  to 
patients  each  session  the  clerk  determines  the  figures  entered 
daily  on  "Exhibits  11 "  to  show  the  number  of  visits  to  each  clinic 
and  the  number  of  new  patients  for  such  clinic,  and  the  total 
visits  made  by  all  patients  to  be  entered  on  "Exhibit  13." 

The  cardboard  sequence  numbers  or  letters  given  to  patients 
each  day  are  left  by  the  patients  in  the  clinic  room,  in  which  they 
are  treated  and  are  returned  with  the  histories  to  the  clerk  after 
the  session  is  over. 

These  sequence  numbers  and  letters  are  then  sorted  and  put 
back  in  the  proper  holders  in  numerical  or  alphabetical  order 
ready  for  use  again  at  the  next  session. 

Missing  numbers  or  letters  are  replaced  by  stamping  with  rub- 
ber stamps  the  proper  numbers  or  letters  on  the  small  round  cards, 
of  which  reserve  stocks  are  kept  on  hand  and  can  be  obtained 
from  some  of  the  large  manufacturers  of  such  cards. 

A  form  as  illustrated  by  "Exhibit  11 "  is  used  each  month  for 
each  different  clinic,  and  on  this  form  the  clerk  records  daily  the 
information  called  for.  The  date  of  each  visit  of  a  patient  is 
recorded  by  a  rubber  stamp  on  the  history  of  such  patient  by  the 
clerk  before  the  history  is  sent  to  the  clinic  which  is  treating  such 
patient.  At  the  close  of  each  session  of  the  Out -Patient  Depart- 
ment the  history  of  each  patient  who  has  visited  a  clinic  is  returned 
to  the  clerk.  From  the  dates  on  these  histories  the  clerk  secures 
the  information  to  record  the  patient  in  the  proper  column  on 
Exhibit  11.  The  first  visit  which  any  patient  makes  in  each  month, 
which  is  the  first  date  for  such  month  appearing  on  his  history, 
is  the  only  time  he  is  recorded  as  a  patient  treated  in  the  first, 
second,  or  fourth  columns  of  Exhibit  11,  as  the  case  may  be. 

The  same  patient  should  only  be  recorded  once  in  any  one 
month  in  the  third  column  of  Exhibit  11,  in  case  he  is  transferred 
from  another  clinic  of  the  Out -Patient  Department.  Thus  when 
the  first  four  columns  are  totaled  at  the  end  of  each  month,  the 
totals  show  the  actual  number  of  patients  treated  in  such  clinic 
during  the  month  classified  as  shown  by  the  headings. 

At  the  end  of  each  month  the  totals  for  each  cUnic,  as  shown 
on  Exhibits  11,  are  transferred,  summarized  and  totaled  on  "Exhi- 
bit 12"  and  the  figures  to  be  set  opposite  corresponding  headings 


Patients  Treated  During  Montli  of 

191 

Clinic, 

Out  Patient  Dept. 

Date 

Former  Patients'treated, 

who  have  not  been  treated 

in  any  previous  month 

of  present  fiscal  year 

Former  Patients  treated. 

who  have  been  treated 

in  some  previous  month 

of  present  fiscal  year 

Patients  treated 
who  were  transferred 

from  other  depart- 
-    ments  of  O.  P.  D. 

New 
Patients 
Treated 

Total 
Patients 
Treated 

Visits 
Made 

Surgical 

Dressings 

Made 

1 

2 

3 

4 

S 

6 

7 

8 

9 

10 

11 

12 

- 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

EX 

HBIT  11  size  1 

0"   X  8" 

28 

29 

30 

31 

Total 

Day 

Number  of  days  Clinic  was  open                          Average  visits  iier  oatlent 

Record  same  patient  only  once  in  any  one  of  first  four  columns. 

Summary 

of  Patients  Treated  ia  Out  Patient  Department  du 

ring 

Mont 

hof_ 

IQl 

NAMES  OF  CLINICS 

Former  Patients 

treated  who  have  not 

been    treated  in  any 

previous  month  of 

present  fiscal  year 

Former  Patients 
treated  who  have  been 
treated  in  some 
previous  month  of 
present  fiscal  year 

Patients 

transferred 

from  other 

departments  of 

O.  P.  D. 

New  Patients 
Tpeated 

Total  Patients 
Treated 

Visits 
Made 

Surgical 

Dressings 

Made 

Male 

Fmle. 

Total 

Male 

Pmle. 

Total 

Male 

Fmle. 

Total 

Male 

Fmle. 

Total 

Male 

Fmle. 

Total 

^ 

■ 

1 

E 

CHII 

51 T 

12  s: 

LZe 

10* 

X  8' 

/ 

i>       .. 

Total 

\                                                    Average  per  day 

1                                                                   Number  of 

)ays 

}.    P. 

D.  was 

open 

/ 

.verat 

e  Vi 

Its  per 

•atlen 

t 

Pres 

riptic 

ns  Fille(| 

Numtier  of  leases 

Rejec 

ed 

Cash 

Rece 

pts 

1 

.1 


i 


Out  Patient  department       i 

yionth  f>f 

191 

Date 

Visits  Made  by  all 
Patients 

Visits  Made 

by  Follow-up 

Patients 

Patients 

admitted  to  Wards 

from  O.P.D. 

rt    Si 

§ 

'is 

1? 

Free 

Pay 

Total 

Medical 

Surgical 

Medical 

Surgical 

1 

3 

g 

9 

11 

12 

13 

IR 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

E 

CHTBTT  1 

?  Size 

LO"   X  8'' 

28 

29 

30 

31 

Total 

II  Day 

OUT-PATIENT  DEPARTMENT  STATISTICS  lis 

for  the  Out-Patient  Department  on  Exhibit  1  are  thus  obtained. 

The  object  of  having  the  subdivisions  "Former  Patients 
Treated,  who  have  not  been  treated  in  any  previous  month  of 
present  fiscal  year"  and  "Former  Patients  treated,  who  have  been 
treated  in  some  previous  month  of  present  fiscal  year"  is  so 
that  if  it  is  desired  to  find  out  how  many  different  patients  have 
actually  been  treated  in  any  particular  clinic  during  a  period  of 
months  or  a  year  this  information  can  be  accurately  obtained  by 
adding  the  monthly  figures  during  such  period  showing  "Former 
Patients  treated,  who  have  not  been  treated  during  any  previous 
month  of  present  fiscal  year,"  "Patients  treated  who  were  trans- 
ferred from  other  departments  of  the  Out -Patients  Department" 
and  "New  Patients  Treated."  Only  by  using  these  classifications 
is  it  practicable  to  determine  accurately  the  actual  number  of 
different  patients  treated  in  the  Out-Patient  Department  during 
a  series  of  months  or  during  a  year.  By  new  patients  is  meant 
patients  who  have  not  been  treated  previously  by  the  Out-Patient 
Department  or  Hospital. 

On  "Exhibit  13"  the  clerk  records  daily  the  information  called 
for  by  the  headings. 

The  colored  sequence  numbers  and  letters  distributed  for  each 
cUnic  show  the  total  number  of  visits  made  to  such  clinic  each  day 
and  by  adding  these  totals  the  total  number  of  visits  made  by  all 
patients  is  determined.  A  satisfactory^  way  of  counting  how  many 
of  these  visits  are  free  visits  has  been  for  the  clerk  to  use  a  small 
inexpensive  mechanical  counter  or  tallying  register.  Every  time 
a  visit  is  made  for  which  the  patient  is  unable  to  pay  the  nominal 
fee  charged,  the  clerk  presses  the  lever  of  the  tallying  register  so 
that  by  looking  at  the  register  at  the  end  of  the  session  the  total 
number  of  free  visits  is  ascertained. 

By  deducting  the  number  of  free  visits  from  the  total  visits 
made  the  number  of  pay  visits  is  found. 

Visits  Made  by  "Follow  Up"  Patients 

When  a  ward  patient,  whom  it  is  desired  to  "follow  up"  leaves 
the  Hospital  he  is  given  a  white  card,  if  a  medical  case,  and  a 
salmon  colored  card,  if  a  surgical  case,  as  illustrated  on  "Exhibit 
14."  These  cards,  printed  differently  on  each  side,  bear  the  name 
and  history  number  of  the  patient  and  on  the  front  or  back  of 
the  card  is  shown  the  time  at  which  he  should  return  to  the  Out- 
Patient  Department  for  further  examination  or  treatment. 


114 


VISITS  MADE  BY  "  FOLLOW  UP  "  PATIENTS 


When  a  follow  up  patient  comes  to  the  Out-Patient  Depart- 
ment he  is  given  a  cardboard  follow  up  sequence  number,  as 


Name 


No. 


Please  come  to  the  Out  Patient  Department, 
Madison  Ave.  and  70th  St.,  at  9  A.  M.  on 

if  you   change  your  address,   please  send  new  address  to 

The  Presbyterian  Hospital  Record  Rootn 
41   East   70th    St.,   New   York  City. 

EXHIBIT  14  elB*  5"  X  3" 
prlBted  dlfferenrtlj  en  each  aide 

ALWAYS  BRING   THIS  CARD 


DATE  OF  NEXT  RETURN 


EXHIBIT    14 


reverse  side 


shown  herewith,  to  indicate  the  order  in  which  he  is  to  be  examined. 
The  clerk  also  secures  the  patient's  history  from  the  History 
Room  and  sends  it  to  the  room  where  follow  up  patients  are 
received. 

If  follow  up  medical  cases  are  examined  during  the  same  hours 
as  follow  up  surgical  cases  it  would  be  desirable  to  have  sequence 
numbers  for  the  former  of  a  different  color  than  for  the  latter,  so 


SOCIAL  SERVICE  DEPARTMENT  STATISTICS  115 

as  to  determine  each  day  by  the  colored  sequence  numbers  dis- 
tributed how  many  medical  and  how  many  surgical  follow  up 
patients  had  made  visits.  If  the  med- 
ical cases  are  examined  at  different 
hours  than  the  surgical  cases  one  set 
of  follow  up  sequence  numbers  is  suf- 
ficient. 

In  case  a  follow  up  patient  needs 
treatment  in  the  clinic  the  clerk  gives 
him  a  colored  sequence  number  to  in- 
dicate the  room  in  which  the  clinic,  to 
which  he  has  been  assigned,  is  held  and 
the  order  of  his  treatment. 

The  number  of  visits  made  by  follow  up  patients  is  entered 
daily  on  Exhibit  13. 

The  number  of  patients  admitted  to  the  medical  or  surgical 
wards  of  the  Hospital  from  the  Out-Patient  Department  is  entered 
daily  on  Exhibit  13. 

The  amount  of  cash  receipts,  number  of  prescriptions  filled 
and  number  of  patients  rejected  are  entered  daily  on  Exhibit  13. 
The  cash  received  in  the  Out-Patient  Department  is  turned  in 
daily  to  the  Superintendent's  office. 

SOCIAL  SERVICE  DEPARTMENT  STATISTICS 

For  the  purpose  of  obtaining  the  statistics  concerning  cases 
cared  for  by  the  Social  Service  Department  called  for  on  Exhibit 
1  a  form  illustrated  by  "Exhibit  15,"  printed  differently  on  each 
side,  is  used. 

One  of  these  forms  is  used  each  month  for  each  subdivision 
of  the  Social  Service  Department  and  the  information  in  regard 
to  the  cases  cared  for  by  such  subdivision  is  filled  in  daily  under 
the  proper  headings  by  the  nurse  or  person  in  charge. 

It  should  be  noted  that  the  same  case  is  only  recorded  once 
in  any  of  the  first  three  columns  as  a  case  cared  for  in  any  month 
(viz.,  the  first  time  it  is  cared  for  in  such  month),  so  that  the  totals 
will  represent  the  actual  number  of  different  cases  cared  for  during 
the  month  under  the  classification  shown. 

The  total  numbers  of  "Former  Cases  Cared  for,  who  have 
not  been  cared  for  in  any  previous  month  of  the  present  fiscal 


116  SOCIAL  SERVICE  DEPARTMENT  STATISTICS 

year"  plus  the  total  numbers  of  "New  Cases  Cared  for/'  as  shown 
by  the  monthly  reports  for  a  period  of  months  or  for  a  year  would 
show  the  actual  total  number  of  "Cases  cared  for"  durmg  such 
period  of  months  or  year. 

At  the  Presbyterian  Hospital  at  the  present  time  one  of  these 
forms,  Exhibit  15,  is  kept  by  each  of  the  following: 

Head  of  Social  Service  Department,  Hospital  Ward  and  Out- 
Patient  Department  Social  Service  Nurse,  Tuberculosis  Nurse, 
Dietitian,  Follow-up  Medical  Nurse,  Follow-up  Surgical  Nurse, 
and  by  the  Visiting  Pupil  Nurse  in  each  of  three  districts  in  which 
visiting  nursing  is  done. 

At  the  end  of  each  month  the  totals  of  each  report  are  reca- 
pitulated on  the  same  form  and  the  grand  total  figures  for  all  sub- 
divisions are  thus  obtained  to  be  entered  on  Exhibit  1  under  the 
heading  Social  Service  Department. 

On  the  reverse  side  of  Exhibit  15  it  has  been  found  useful  to 
provide  a  form  on  which  nurses  can  enter  daily  their  expenses 
and  disbursements  under  classifications  shown. 

At  the  end  of  each  month,  the  total  receipts,  expenses,  and 
disbursements  of  each  nurse  are  recapitulated  on  the  same  form 
and  the  grand  total  receipts,  expenses,  and  disbursements  of  ail 
the  Social  Service  Department  nurses  are  thus  obtained. 

Visiting  Pupil  Nurses,  who  make  visits  to  homes  of  patients 
for  nursing  care,  and  the  Hospital  Ward  and  Out-Patient  Depart- 
ment Social  Service  Nurses  each  use  a  form,  as  shown  by  "Exhibit 
16,"  on  which  is  recorded  the  name  and  address  of  each  patient 
visited  during  the  month.  On  this  form  is  entered  daily  a  record 
of  visits  made  to  patients  named,  so  that  at  the  end  of  the  month 
the  number  of  visits  made  to  each  patient  is  shown  and  also  the 
total  visits  made  each  day  during  the  month  in  such  department 
or  subdivision. 

The  first  time  a  patient  is  visited  each  month,  as  shown  on 
Exhibit  16,  is  the  only  time  such  patient  is  counted  in  one  of  the 
first  three  columns  of  Exhibit  15  as  a  "Case  Cared  for"  during 
such  month.  If  there  is  any  doubt  as  to  whether  it  is  a  "Former 
Case  Cared  for,  who  has  not  been  cared  for  in  any  previous  month 
of  present  fiscal  year"  or  a  "Former  Case  Cared  for,  who  has  been 
cared  for  in  some  previous  month  of  present  fiscal  year"  or  a 
"New  Case  Cared  for"  this  question  is  settled  by  reference  to 
name  index  cards  or  histories  of  cases  cared  for.  Two  kinds  of 
name  index  cards  are  kept  in  the  same  file.    One  of  these  is  a 


Social  Service  Department,  cases  cared  for  During  Month  ol 


.I9I_ 


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20 

21 

22 

23 

24 

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28 

29 

30 

31 

Total 
Average 
per  Day 

Days  Social  Sarvlce  Dep't.  wai  open 

Record  same  case  only  once  in  columns  marked 


Dept 

^ur«e  or  S.  S.  Worker. 


Expenses 

During  Month  of     . 

I9r 

Cash 
Received 

Nurse's  Carfare 

Patient's  Carfare 

Tele- 
phones 
and 

erams 

station- 
ery 

Postage 

Medicine 

Food 

Clothes 

Carriage 
Hire 

Totals 

street 

R.  R. 

street 

R.  R 

Brouebt 
Forward 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

U 

13 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

EXH 

[BIT  1 

5  reve 

rse  Bl 

de 

28 

29 

30 

31 

Total 

TOTAL 

Social  Service  Department        Visits  to  Patients,  etc.,  During  IWontli  of .19 


Dent 



Nurse  or  Social  Worker 

Address 

Floor 

Whei 
to 

Dates  and  Visits  Made 

Total 

Remarks 

Visit  " 

-^, 

fO 

:^ 

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3 

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lotal  Visits  Made 

Average '  Visits  per  Day 

SOCIAL  SERVICE  DEPARTMENT  STATISTICS 


117 


buff  colored  "Slight  Service  Card"  as  shown  by  "Exhibit  17," 
which  is  printed  differently  on  each  side.  On  this  card  is  recorded 
any  slight  services  rendered  and  the  dates. 


NAME 

HOSFITAL  NO. 

AOORCSS 

FRONT                  RIGHT 

BACK                     LEFT 

FLOOR 

OISFENSARY  NO. 

MOVCO  TO 

FRONT                  RIGHT 

BACK                     LEFT 

FLOOR 

DATE 

MALE 

WHITE 

RELIGION 

FEMALE 

BLACK                                      AGE 

SINGLE 

OCCUPATION                                      WAGES 

BIRTHPLACE 

WIDbWEO 

EXHIBIT  17  slae  5" 

x3" 

3IVORCE0 
iEPARATCD 

printed  differently  on 

each  side 

«M.,..7 

Referred  by 
Referred  for 

Service  rendered 


EXHIBIT  17  reverse  side 


Diagnosis 


The  other  name  index  card  of  a  history  of  a  case  cared  for  is 
a  white  index  card,  as  shown  by  "Exhibit  18,"  which  is  used  to 
show  reference  to  the  Social  Service  History  number  and  the  name 
and  address  of  each  case  that  has  received  continuous  care  or 
more  than  slight  services.  On  the  histories  are  recorded  the  dates 
and  nature  of  continuous  care  or  services  rendered. 


118  COMPARATIVE  STATISTICAL  FIGURES 

If  the  history  apphes  to  the  same  person  for  whom  a  slight 
service  card  had  previously  been  made  out  it  is  customary  to 


SURNAME 

MAN'S    FIRST    NAME 

SOC.  SER.    NO 

WOMAN'S    NAME 
BEFORE    MAHRIAOE 

WOMAN'S    FIRST   NAME 

DATE 

ADDRESSES 

MEMBERS  OF  HOUSEHOLD 

EXHIBIT  18  8i«e  5»  x  5» 

transfer  the  information  on  the  slight  service  card  to  the  history 
and  then  destroy  the  slight  service  card,  so  as  to  have  only  one 
name  index  card  in  the  name  index  file  for  the  same  case. 

COMPAKATrVE   STATISTICAL   FiGURES   FOR   A    PeBIOD    OF   MONTHS 

OR  Year 

In  order  to  have  statistical  figures  in  such  form  that  results 
for  a  series  of  months  or  a  year  can  be  readily  obtained  and  com- 
pared with  other  months  or  years  over  a  period  of  four  or  five 
years,  a  form,  as  illustrated  by  "Exhibit  19,"  has  been  found  very 
satisfactory  and  useful. 

The  headings  at  the  top  of  the  form  can  be  filled  in  to  suit  the 
statistical  information  desired.  By  adding  the  monthly  amount 
for  each  month  to  the  amount  shown  in  the  "To  Date"  column 
opposite  the  previous  month,  the  amount  to  date,  or  from  the  first 
of  the  fiscal  year  to  the  end  of  the  month  concerned,  is  obtained. 

A  similar  form,  ruled  with  dollars  and  cents  columns,  may 
be  used  where  comparative  month  and  to  date  figures  are  desired 
which  represent  receipts  or  expenditures,  etc.  This  is  the  form 
of  "Comparative  Month  and  To  Date  Statement"  referred  to  on 
page  59. 


P  A 

T  I  E  N  T  S     ;i 

D  U  I 

T  T  E  E 
1 

1 

f  A  T  I  E  N 

T  S     DISC 

H  A  R  G  E  D 
Transferred  | 

Died 

= 

17 
18 

17 
18 

Ma 

^°  "'" 

Medlca 

Pem 

1  Wards 
ale 

T( 

tal 

Mc 

le 

jurglca 
Pel 

ale 

T 

c: 

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Tital 



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MCHTH 

- 

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17 
18 

■   16 
19 

IE 

- 



1 

: 

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18 

- 

19 
Mai? 



- 

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16 

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16 

- 

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- 

16 
19 

k4l 

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IB 

19 

Jul|? 

IS 

19 
Ao|? 



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16 

19 

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19     StlzE  2^A" 

1 

18 

19 
T.t^? 

- 

1 

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1 

1— 

== 

j 

p 

COMPARATIVE  STATISTICAL  FIGURES  119 

The  use  of  such  forms  greatly  faciUtates  obtaining  promptly 
at  the  close  of  each  fiscal  year  the  figures  showing  the  various 
subdivisions  of  revenue,  expenses,  and  statistics  required  for  the 
annual  report. 

It  has  been  found  convenient  to  keep  the  forms  shown  by 
Exhibits  1,  2,  11,  12,  13,  and  15  filed  in  suitable  Post  or  Spring 
Back  Binders  in  which  they  can  be  easily  inserted  or  from  which 
they  can  be  readily  removed. 


Y^VaA      y,c-^.  «..H/»CviK^^^    ^r^, 


